1. When should I have my first gynecology exam and/or Pap test?

Gynecology exams begin at 18 or earlier if needed.  We are happy to see younger women to discuss contraception, screening for sexually transmitted infections, or any other gynecologic concerns or questions. Pap tests begin at age 21. 

2. What should I do if I think I have a vaginal infection or urinary tract infection?

Please call our office for an appointment.  Generally, same day appointments are available.  Infections can have varying symptoms and it is important to be evaluated by your provider to ensure the correct diagnosis and treatment.

3. What should I think about when starting birth control pills?

Consider how easily you will remember to take a daily pill.  Pills do not protect against HIV or any other sexually transmitted infections.  It is best to be a non-smoker.  Women over 35 who smoke cannot take estrogen containing birth control pills.  Be sure to discuss your personal medical history with Dr. T to be sure there are no reasons that you cannot use the pill. 

4. What should I do if I forget to take a birth control pill?

If you miss one pill, take it as soon as you remember.  If you do not remember until the next day, take two pills at the same time.  If you miss two days, take two pills for the next two days and use a back-up method of contraception such as condoms for the remainder of the pill pack.  Be aware that taking two pills can sometimes cause nausea.  Missing pills or taking pills late can sometimes result in very light vaginal bleeding and can also decrease the efficacy of your birth control. Try to take your pills at the same time every day so you are less likely to forget.  Setting a daily reminder on your phone may help you remember.  If you consistently have trouble remembering to take your pills on time, talk to your provider about alternative methods of contraception.

5. Can I get an Intrauterine Device (IUD)?

Intrauterine contraception is highly effective, long acting, and rapidly reversible.  It is a safe option for most women.  Ideal candidates are women who desire long-term contraception, are not planning pregnancy for at least a year, are in mutually monogamous long term sexual relationships, and desire non-estrogen methods. Mirena, Skyla, Kyleena, and Paragard IUDs are available in our office.  They are inserted during your period so be sure to call on your first day to schedule.  If you recently had a baby and are breastfeeding, you will not be menstruating and can schedule the insertion.

6. I recently started hormonal birth control and am having irregular bleeding. Is this normal?

You can expect spotting or irregular bleeding for the first three to six months after starting hormonal contraception such as birth control pills, NuvaringMirena, and Implanon/Nexplanon.  This is a common side effect, not harmful, and should improve with time.  It does not mean that your contraception is not working. Sometimes women miss their period completely when using hormonal contraception.  As long as you have been using it correctly this is of little concern.  Check a pregnancy test if you miss two periods in a row or have pregnancy symptoms.  Any reputable store brand used first thing in the  morning will work. 

7. Should I take the morning after pill?

Emergency contraception, also called the morning after pill, helps prevent pregnancy after unprotected sex or birth control failure.  It is more effective if taken within the first 72 hours, but can be taken for up to five days after the incident.  It is available over the counter for women 17 years or older.  A prescription is necessary if you are 16 or under.  If you are already pregnant emergency contraception will not affect or abort an existing pregnancy.

8. Can I have a pap test if I have my period?

No, you should not have a pap smear or annual exam while you are having any spotting or bleeding.  Please call the office to reschedule.

9. Should I be tested for Human Papilloma Virus (HPV)?

HPV is a very common virus for women in their twenties and is usually only significant if a Pap test is abnormal or if HPV persists consistently after age thirty.  Starting at age thirty women should have a Pap test along with testing for HPV.

10. Should I get the Human Papilloma Virus (HPV) vaccine (Gardisil)?

The HPV vaccine (Gardasil) is administered to females and males age 9-26 in three doses over a six month period.  The Centers for Disease Control and ACOG recommend routine HPV vaccination to girls at age 11 or 12.  The vaccine is most effective when given before any exposure to HPV (i.e. before sexual activity) and produces higher antibody when given at this age compared to older ages.  Girls and women age 13-26 can still receive the vaccine if they have not previously.  The HPV vaccine is not recommended for pregnant women.

HPV can cause genital warts, precancerous lesions of the cervix and vagina, and cervical cancer.  The HPV vaccine helps protect against diseases caused by HPV Types 6, 11, 16, and 18.  These four types of HPV cause approximately 70% of cervical cancers and 90% of genital warts.  However, because there are more than 100 types of HPV, the vaccine will not protect against all HPV types.  The vaccine will also not protect against HPV types to which you have already been exposed.  However, since exposure to all four HPV types prevented by the vaccine is unlikely, vaccination may still provide some benefit.  Vaccination does not eliminate completely the chance of developing precancerous or cancerous lesions of the cervix, so it is still imperative that routine Pap testing continues.

The HPV vaccine is administered in three doses.  The second dose is given two months after the first dose and the third dose is given six months after the first one.  If the second or third doses are not given at those exact intervals they can be given at any time and the earlier doses do not need to be repeated.  Insurance companies will only pay for doses completed by the 27th birthday.

11. How often do I need a Pap test?

Pap testing begins at age 21.  Between ages 21 and 29, Pap tests are performed  every three years.  Beginning at age 30, Paps with testing for high risk HPV are performed every five years.  Based on an individual patient's history these intervals may change.  Please discuss your recommended interval with Dr. Trebian.  Pap tests are not performed after age 65 except under unusual circumstances.  Even though you may not need a Pap test annually, you should still schedule a yearly gynecologic exam.  A physical exam including breast and pelvic exam will be performed, prescriptions refilled, referrals provided as needed, as well as any other concerns addressed.

12. What should I do if I think I have a sexually transmitted infection (STI)?

Call our office for an appointment.  Early treatment helps to minimize long-term effects of STIs.  Avoid sexual contact until you are treated.  Some STIs may have mild or no symptoms at all so intermittent screening can be beneficial.

13. Will I know if I have a sexually transmitted infection (STI)?

No, not necessarily.  Many sexually transmitted infections may have mild or no symptoms and can be transmitted without knowing.  The only way to know for sure is to get tested.

14. What should I do if I miss my period?

If you are sexually active and could be pregnant take a home pregnancy test or call us for an appointment.  If you are using hormonal contraception skipping periods may be a side effect of your contraceptive method. If you are not on any medication and have not had a period for three months, please call our office for an appointment.

15. When should I get my first mammogram?

The American Cancer Society and ACOG recommend annual mammograms starting at age 40.  The United States Preventive Services Task Force recommends biennial screening mammography starting at age 50.  If you are at high risk of developing breast cancer due to personal or family history mammograms before age 40 may be indicated, as well as other enhanced screening such as breast MRIs. 

16. What can I do about my menopausal symptoms?

Lakeside OB/GYN specializes in the treatment of menopause, including the discussion of lifestyle strategies, the use of bioidentical hormones, and conventional hormone therapy.  Please call our office to schedule a consultation if you would like more information.



The American Congress of Obstetricians and Gynecologists

Organization of Teratology Information Specialists

Centers for Disease Control and Prevention

The American Society for Colposcopy and Cervical Pathology

American Cancer Society

Patient Resources