Preventive Care & Screenings

Health Insurance and Women

What is health insurance?

Health insurance is a formal agreement to provide and/or pay for medical care. The health insurance policy describes what medical services are "covered" by the insurance company. There are medical services that are not "covered" and will not be paid by your insurance company.

There are a variety of private and public health insurance programs. Most women obtain health insurance through their employer or as a "dependent" in a family plan. There also are public health insurance plans funded by the federal and state governments.

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How does health insurance affect me?

More than 17 million women (nearly one in five) age 18 to 64 are uninsured in the United States. As health insurance costs soar, employers cut benefits, or jobs disappear, millions of people slip through the cracks and lose their coverage. These are working Americans who make too much money to qualify for Medicaid, but don't have enough money to buy health insurance. Also, women are twice as likely as men to be insured as a "dependent" on a spouse's plan. So, she risks losing coverage if she divorces, is widowed, or if her spouse loses his job.

Uninsured women are more likely to suffer serious health problems. They tend to wait too long to seek treatment, and many don't fill needed prescription drugs because of cost. Also many don't get preventive care, including lifesaving screening tests such as mammorgrams and Pap tests. The lack of health insurance can even be deadly as research has shown that uninsured adults are more likely to die earlier than those who have insurance.

The rising costs of health insurance also affect insured women. According to one national survey, one in six privately insured women postponed or went without needed care because she could not afford it. In 2005, a typical insurance premium for individuals cost $4,024 and $10,800 for families.

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What are my health care options?

Health insurance can be complicated and confusing. There are different types of plans:

Private Health Insurance

There are two major types of private health insurance:

1. Fee-for-service. The provider (such as a doctor or hospital) gets paid for each covered service. With this type, you go to a doctor of your choice, then the doctor or hospital submits a claim to your insurance company for payment. The insurance company will only pay the provider for "covered" services. Most fee-for-service plans have a deductible amount that you must pay each year before the insurance company will begin to pay for medical services. Many plans also require you to pay a portion of the medical expense—called "coinsurance."
2. Managed care. Managed care plans have contracts with certain doctors, hospitals and other providers to provide medical services to plan members. The three main types of managed care plans are:

• Health Maintenance Organizations (HMOs). They provide health services for a fixed monthly payment, called a "premium." This monthly premium is the same whether you use the plan's services or not. The plan may charge a copayment for some services—for example $10 for an office visit or $5 for a prescription. HMO plans usually require you to select a primary care physician (PCP), who manages your care. As long as you use the doctors and hospitals that participate in the HMO, your out-of-pocket costs should be very small. The HMO Act of 1973 created this alternative to traditional health plans as a more affordable option.
• Preferred Provider Organization (PPO). This option offers more choices than an HMO, but premiums often are higher. Most PPO plans do not require you have a PCP to manage your care. You can keep your out-of-pocket costs low by using "in-network" providers.
• Point of Service (POS). This plan is similar to a PPO, but your care is managed by a PCP. For example, with a POS plan, you would need a referral from your PCP to see a specialist.

People who have private insurance either buy it themselves or get it through their employer, called "group insurance." Group insurance obtained through an employer typically requires the employee to pay some of the overall policy cost.

Comparison between Employer-Sponsored and Private Health Insurance

Employer-Sponsored	Group policy paid in whole or in part (typically 73-84%) by employer	Typically fee-for-service or managed care plan
Individually Purchased	Individual policy, more costly, benefits usually more limited	Typically fee-for-service or managed care plan

Public Health Insurance

The government also provides health care coverage for qualifying women through Medicaid, Medicare, and special interest programs. These plans serve those who meet certain financial, age, or situational requirements. Government health insurance programs include:

• Medicare. This is the national health insurance program for people age 65 or older, under age 65 with certain disabilities, and any age with permanent kidney failure. How you get your health care coverage depends on the Medicare plan you select. The Original Medicare Plan has three parts:

• Part A (hospital) covers inpatient hospital, skilled nursing, home health, and hospice services. Everyone over age 65 is entitled to Part A.
• Part B (medical) covers outpatient hospital, doctor, lab, and other services. Part B also covers preventive services important to women, such as yearly mammogram, Pap smear, bone density scan, and flu shots. Part B is optional. You have to purchase Part B.
• Part D covers prescription drugs. Part D is optional. You have to purchase Part D. Private companies approved by Medicare run these plans. Plans cover different drugs, but drugs that you must have to treat a health problem are covered.

Some people also choose to purchase a "Medigap" policy to help pay for medical services and supplies not covered by Part A and Part B. Costs for this type of private insurance vary by policy and company.

Medicare also offers Medicare Advantage Plans. These are health plans like HMOs and PPOs that are approved by Medicare and run by private companies. They are part of the Medicare Program, and sometimes called “Part C.” These plans provide all of your Part A and Part B coverage. Many also include Part D drug coverage. Your costs may be lower than in the Original Medicare Plan, and you may get extra benefits.

For more information, call 1 (800) 633-4227 (MEDICARE) or go to http://www.medicare.gov.

• Medicaid. Medicaid provides health care to certain low-income individuals and families with limited resources. Medicaid does not pay money to you. Instead, it sends payments directly to your health care providers. Medicaid is a state and federally funded program. Although the federal government sets general program rules, each state defines its own eligibility rules and runs its own program services. Qualification in one state does not mean you will qualify in another state. You must be a U.S. national, citizen or permanent resident alien in order to apply for benefits. For more information, call 1 (877) 0267-2323 or go to http://www.cms.hhs.gov/home/medicaid.asp
  
  Note: Many states have become more flexible in their ability to serve families in need, especially if you fall into any of these categories:

• Pregnant—Both you and your child will be covered if you qualify.
• Children/Teenagers—May cover sick children or teenagers on their own.
• Aged, Blind, and/or Disabled—Nursing home and hospice care available.
• Leaving welfare—You may be able to get temporary assistance.
  
  Call your local social security office for more information.

• State Children's Health Insurance Program (SCHIP). This is a joint state and federal program that provides insurance for children of qualifying families. Families who make too much money to qualify for Medicaid but cannot afford private health insurance may be able to qualify for SCHIP assistance. Eligibility and health care coverage varies according to each state. For more information, contact http://www.insurekidsnow.gov or call 1 (877) 543-7669 (KIDS NOW).

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How do I choose a health plan?

When it comes to health plans, not everyone has a choice. But if you do, you will need to understand the how different plans affect your choice of providers and services, costs, and quality of care. This information can be confusing. Few people understand their options well enough to make an informed choice. For help making a decision based on quality, see Choosing a Health Plan.

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I don't have health insurance. What are my options?

More than 46 million people in the United States are uninsured, and most are in working families. The government is looking for ways to provide more affordable health insurance and greater access to health care. Right now, there are a number of resources for women without health insurance. There are government-sponsored "safety-net" facilities that provide medical care for those in need, even if they have no insurance or money. Safety-net facilities include community health centers, public hospitals, school-based centers, public housing primary care centers, migrant health centers, and special needs facilities. The U.S. Department of Health and Human Services (HHS) recently awarded more than $19 million to expand and strengthen these facilities. To find a facility near you, contact your local or state health department or visit the Bureau of Primary Health Care.

Other government-sponsored programs for uninsured women include:

• Special Supplemental Nutrition Program for Women, Infants, & Children (WIC). Provides healthy foods to supplement diets, nutrition education, and referrals to health care for low-income women, infants, and children up to age 5. Contact: http://www.fns.usda.gov/wic.
• National Breast and Cervical Cancer Early Detection Program (NBCCEDP). Provides free or low-cost mammograms and pap tests for women over age 39 who cannot afford breast exams or Pap smears. Contact: http://www.cdc.gov/cancer/nbccedp or 1-888-842-6355.
• Maternal and Child Health Services. State programs provide health care services for low-income women who are pregnant and their children under age 22. The federal government funds these programs and establishes general guidelines regarding services. Each state determines eligibility and identifies the specific services to be provided. The Title V State MCH Toll-free Hotline Directorycan help you find services in your state.
• Indian Health Service (IHS). Provides public health care services to American Indians and Alaskan Natives. Generally, one must be an enrolled member of a Federally recognized tribe to be eligible for health services from the IHS. Non-Indian women who are pregnant with an eligible Indian’s child also may receive health care service from the IHS. Contact: www.ihs.gov.
• Projects for Assistance in Transition from Homelessness (PATH). Federal grants are provided to states and territories that partner with local organizations to provide a variety of health services for homeless people who have serious mental illness. Contact: http://www.pathprogram.samhsa.gov.

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What if I do not qualify for these government programs?

Some uninsured women make too much money to qualify for government assistance but cannot afford to pay for health insurance or costly medical care. This is a difficult situation for women and their families. There are options for women in this situation, including:

• Free clinics. Free clinics provide services for the working poor and uninsured. Usually, people who qualify for Medicare, Medicaid or who can afford private insurance do not qualify for care in free clinics. The Free Clinic Foundation of America publishes a National Directory of Free Clinics. To access the directory, visit www.medkind.com.
• Prescription drug assistance. Some states provide prescription drug assistance to women who are not covered by Medicaid. Also, many drug companies will work with your doctor or health care provider to supply free medicines to those in need. For prescription drug resources, go to:http://www.disabilityresources.org/RX.html.
• Women with cancer. Women who are coping with cancer can find help through many government-sponsored and volunteer organizations. For example, Cancer Care provides free support, information, financial help, and practical help to people with cancer and their families. Low-income and underserved women with breast and cervical cancers can get help with transportation, child care, and home care from the AVONCares Program. For more information and a list of more resources, contact the National Cancer Institute at www.cancer.gov/cancertopics/factsheet/Support/financial-resources.
• Women with HIV. The federal Ryan White CARE Act funds services for those with HIV/AIDS who have little or no insurance and limited income. For information about the Ryan White Care Act, go tohttp://hab.hrsa.gov. Contact your local or state health department to locate a CARE provider in your area. Resources also can be found at www.aids.gov.
• Low-Cost Health Insurance Options. Some labor unions, professional clubs, associations, and organizations offer private group health insurance to its members. These plans usually are less costly and may be an option to consider.
• State Temporary Insurance. Some who have been denied health insurance because of a medical condition may be able to obtain coverage through State "High Risk Pools." More than 30 states provide this temporary insurance assistance. For more information, contacthttp://www.healthinsurance.org/risk_pools.

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How can I protect my health insurance benefits?

If you are losing your health insurance due to job loss or reduced hours, there are some important steps you should take. Women and their dependent children who lose their health insurance through divorce or death also are entitled to the following protection.

• Get proof of previous health insurance coverage from your employer. This assures certain protections and rights under the Health Insurance Portability and Accountability Act of 1996, or HIPAA. Basically, HIPAA protects employed individuals and their families who are insured by continuing access to health insurance when leaving or changing jobs. For more information about HIPAA and how it affects you and your family, go tohttp://www.cms.gov/hipaa/hipaa1/content/more.asp.
• You may be able to continue your group health insurance coverage under the Consolidated Omnibus Budget Reconciliation Act of 1985, or COBRA. Generally, employers with 20 or more employees are subject to COBRA and must allow you the option to continue your health insurance benefits for at least 18 months after leaving your job. You will have to pay more than when you were employed because you also must pay the premium costs your employer used to pay for you. But you will receive the same health benefits while you look for another job or until you buy health insurance. In some cases, you can apply for health insurance continuance after using up your COBRA coverage through your state-mandated "High-Risk Pool" Insurance.
• Consider your health insurance situation carefully before agreeing to certain terms and conditions. This is very important if you and your spouse separate or divorce. Also, you may not want to give up certain survivor or retirement benefits as this could impact your health insurance benefits.
• A court order can be obtained to provide insurance coverage for children under a divorced parent's health plan, even if that parent does not have custody. This court order is called a qualified medical child support order.
• In most cases, there are strict time limitations in which to apply for benefits. So act quickly to get the right information and file the forms required in order to protect you and your family's health insurance.

Heart Healthy Eating

Why do I need to be concerned about heart healthy eating?

What you eat affects your risk for having heart disease and poor blood circulation, which can lead to a heart attack or stroke. Heart disease is the number 1 killer and stroke is the number 3 killer of American women and men.

In the main type of heart disease, a fatty substance called plaque builds up in the arteries that bring oxygen-rich blood to the heart. Over time, this buildup causes the arteries to narrow and harden. When this happens, the heart does not get all the blood it needs to work properly. The result can be chest pain or a heart attack.

Most cases of stroke occur when a blood vessel bringing blood to the brain becomes blocked. The underlying condition for this type of blockage is having fatty deposits lining the vessel walls.

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What foods should I eat to help prevent heart disease and stroke?

You should eat mainly:

• fruits and vegetables
• grains (at least half of your grains should be whole grains, such as whole wheat, whole oats, oatmeal, whole-grain corn, brown rice, wild rice, whole rye, whole-grain barley, buckwheat, bulgur, millet, quinoa, and sorghum)
• fat-free or low-fat versions of milk, cheese, yogurt, and other milk products
• fish, skinless poultry, lean meats, dry beans, eggs, and nuts
• polyunsaturated (pol-ee-uhn-SACH-uh-ray-tid) and monounsaturated (mon-oh-uhn-SACH-uh-ray-tid) fats (found in fish, nuts, and vegetable oils)

Also, you should limit the amount of foods you eat that contain:

• saturated fat (found in foods such as fatty cuts of meat, whole milk, cheese made from whole milk, ice cream, sherbet, frozen yogurt, butter, lard, cakes, cookies, doughnuts, sausage, regular mayonnaise, coconut, palm oil)
• trans fat (found mainly in processed foods such as cakes, cookies, crackers, pies, stick or hard margarine, potato chips, corn chips)
• cholesterol (koh-LESS-tur-ol) (found in foods such as liver, chicken and turkey giblets, pork, sausage, whole milk, cheese made from whole milk, ice cream, sherbet, frozen yogurt)
• sodium (found in salt and baking soda)
• added sugars (such as corn syrup, corn sweetener, fructose, glucose, sucrose, dextrose, lactose, maltose, honey, molasses, raw sugar, invert sugar, malt syrup, syrup, caramel, and fruit juice concentrates)

Eating lots of saturated fat, trans fat, and cholesterol may cause plaque buildup in your arteries. Eating lots of sodium may cause you to develop high blood pressure, also called hypertension. Eating lots of added sugars may cause you to develop type 2 diabetes. Both hypertension and diabetes increase your risk of heart disease and stroke.

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How can I tell how much saturated fat, trans fat, and other substances are in the foods I eat?

Prepared foods that come in packages — such as breads, cereals, canned and frozen foods, snacks, desserts, and drinks — have a Nutrition Facts label on the package. The label states how many calories and how much saturated fat, trans fat, and other substances are in each serving. For information on how to read a Nutrition Facts label, see the Fitness and Nutrition section of womenshealth.gov.

For food that does not have a Nutrition Facts label, such as fresh salmon or a raw apple, you can use theU.S. Department of Agriculture (USDA) National Nutrient Database . This is a bit harder than using the Nutrition Facts label. But by comparing different foods you can get an idea if a food is high or low in saturated fat, sodium, and other substances. To compare lots of different foods at one time, check out theNutrient Lists.

What is a calorie?

When talking about a calorie in food, it is a measure of the energy that the food supplies to your body. When talking about burning calories during physical activity, a calorie is a measure of the energy used by your body. To maintain the same body weight, the number of food calories you eat during the day should be about the same as the number of calories your body uses.

The number of calories you should eat each day depends on your age, sex, body size, how physically active you are, and other conditions. For instance, a woman between the ages of 31 and 50 who is of normal weight and moderately active should eat about 2,000 calories each day.

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Are there eating plans that can help me choose foods that are good for my heart?

There are four eating plans that can help you choose heart healthy foods:

• MyPyramid eating plan
• Dietary Approaches to Stop Hypertension (DASH) eating plan
• Heart Healthy Diet
• Therapeutic Lifestyle Changes (TLC) Diet

The MyPyramid eating plan is based on the Dietary Guidelines for Americans. It was developed by the U.S. Department of Agriculture and the U.S. Department of Health and Human Services to help people lower their risk of serious diseases linked to diet, including heart disease. DASH was developed by the National Heart, Lung, and Blood Institute (NHLBI) to help people with hypertension lower their blood pressure. But it can also be used to help prevent heart disease. The Heart Healthy Diet was developed by NHLBI to help people keep their blood levels of total cholesterol and LDL cholesterol (or "bad" cholesterol) low. The TLC diet was developed by NHLBI to help people with unhealthy blood cholesterol levels.

These eating plans have interactive web sites to help you choose foods that meet their guidelines You key in your age, sex, height, weight, and activity level. Based on this information the web sites give you tips on what types of foods to eat and how much of each type.

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How do these eating plans work?

The four eating plans are similar. They are all designed to help you eat foods that are good for your heart and avoid foods that are bad for your heart. Below is a table comparing the main guidelines of the four eating plans:

Heart-Healthy Eating Plans: How They Compare

	% of the day's total calories from saturated fat	% of the day's total calories from fat	amount oftrans fat	milligrams (mg) of dietary cholesterol per day	milligrams (mg) of dietary sodium per  day
MyPyramid	less than 10%	20-35%	as low as possible	less than 300 mg	less than 2300 mg*
DASH**	5%	22%	as low as possible	136 mg	less than 2300 mg*
Heart Healthy Diet	8-10%	30% or less	as low as possible	less than 300 mg	less than 2400 mg
TLC Diet	less than 7%	25-35% or less	as low as possible	less than 200 mg	less than 2400 mg

*2300 milligrams of sodium in table salt is about 1 tsp of salt. People with hypertension should eat no more than 1500 mg of sodium a day (about 2/3 teaspoon of salt). African Americans and middle-aged and older adults should also eat no more than 1500 mg of sodium per day. The reason is that these groups have a high risk of developing hypertension.

**These DASH guidelines are for someone eating 2000 calories each day.

Notice that all four eating plans limit the amount of sodium you should eat each day to about 1 tsp of salt (2/3 tsp for people with hypertension or at risk for hypertension). Most of the salt we eat each day actually comes from processed foods rather than salt that we add to foods that we cook. Make sure to check the sodium content on the Nutrition Facts label when buying food. The sodium content in similar foods can vary a lot. For instance, the sodium content in regular tomato soup may be 700 mg per cup in one brand and 1100 mg per cup in another brand. Choosing the brands with lower sodium content can be one way to lower the amount of sodium you eat.

Another way to limit sodium is to use spices other than salt. There are plenty of salt-free spice combinations that you can find in your grocery store. It may take awhile for you to get used to the taste. But give it time. After awhile, you may like them better than salt.

Besides limiting the amount of sodium you eat, it is also a good idea to eat foods rich in potassium (puh-TASS-e-uhm). A potassium-rich diet blunts the harmful effects of sodium on blood pressure. Aim to eat 4700 mg of potassium a day. Foods rich in potassium include fruits and vegetables, especially:

• tomatoes and tomato products
• orange juice and grapefruit juice
• raisins, dates, prunes
• white potatoes and sweet potatoes
• lettuce
• papayas

Check out the potassium list in the Nutrient List section of the USDA National Nutrient Database for more foods rich in potassium.

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I've heard that eating fish is good for my heart. Why is that?

Fish and shellfish contain a type of fat called omega-3 (oh-MAY-guh) fatty acids. Research suggests that eating omega-3 fatty acids lowers your chances of dying from heart disease. Fish that naturally contain more oil (such as salmon, trout, herring, mackerel, anchovies, and sardines) have more omega-3 fatty acids than lean fish (such as cod, haddock, and catfish). Be careful, though, about eating too much shellfish. Shrimp is a type of shellfish that has a lot of cholesterol.

You can also get omega-3 fatty acids from plant sources, such as:

• canola oil
• soybean oil
• walnuts
• ground flaxseed (linseed) and flaxseed oil

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Is drinking alcohol bad for my heart?

Drinking too much alcohol can, over time, damage your heart and raise your blood pressure. If you drink alcohol, you should do so moderately. For women, moderate drinking means one drink per day. For men, it means two drinks per day. One drink counts as:

• 5 ounces of wine
• 12 ounces of beer
• 1½ ounces of 80-proof hard liquor

Research suggests that moderate drinkers are less likely to develop heart disease than people who don't drink any alcohol or who drink too much. Red wine drinkers in particular seem to be protected to some degree against heart disease. Red wine contains flavonoids (FLAY-vuh-noidz), which are thought to prevent plaque buildup. Flavonoids also are found in:

• red grapes
• berries
• apples
• broccoli

On the other hand, drinking more than one drink per day increases the risks of certain cancers, including breast cancer. And if you are pregnant, could become pregnant, or have another health condition that could make alcohol use harmful, you should not drink.

With the help of your doctor, decide whether moderate drinking to lower heart attack risk outweighs the possible increased risk of breast cancer or other medical problems.

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I need help working out an eating plan that's right for me. Who can I ask for help?

You may want to talk with a registered dietitian. A dietitian is a nutrition expert who can give you advice about what foods to eat and how much of each type. Ask your doctor to recommend a dietitian. You also can contact the American Dietetic Association (see the resources section for more information).

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Besides eating healthy foods, what else can I do to keep my heart healthy?

To reduce your risk of heart disease:

• Quit smoking — talk with your doctor or nurse if you need help quitting.
• Get at least 2 hours and 30 minutes of moderate aerobic physical activity each week. For more information on physical activity, see the Fitness and Nutrition section of womenshealth.gov.
• Lose weight if you are overweight, and keep a healthy weight.
• Get your blood pressure, cholesterol, and blood sugar levels checked regularly. For guidance on how often you should get tested, see Screening Tests and Immunizations Guidelines for Women.

Lesbian Health

What challenges do lesbian women face in the health care system?

Lesbians face unique challenges within the health care system that can cause poorer mental and physical health. Many doctors, nurses, and other health care providers have not had sufficient training to understand the specific health experiences of lesbians, or that women who are lesbians, like heterosexual women, can be healthy normal females. There can be barriers to optimal health for lesbians, such as:

• Fear of negative reactions from their doctors if they disclose their sexual orientation.
• Doctors’ lack of understanding of lesbians’ disease risks, and issues that may be important to lesbians.
• Lack of health insurance because of no domestic partner benefits.
• Low perceived risk of getting sexually transmitted diseases and some types of cancer.

For the above reasons, lesbians often avoid routine health exams and even delay seeking medical care when health problems occur.

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What are important health issues for lesbians to discuss with their doctors or nurses?

• Heart disease. Heart disease is the #1 killer of all women. Factors that raise women’s risk for heart disease — such as obesity, smoking, and stress — are high among lesbians. The more risk factors (or things that increase risk) a woman has, the greater the chance that she will develop heart disease. There are some factors that you can't control such as getting older, family health history, and race. But you can do something about some of the biggest risk factors for heart and cardiovascular disease — smoking, high blood pressure, lack of exercise, diabetes, and high blood cholesterol.
• Exercise. Studies have shown that physical inactivity adds to a person's risk for getting heart and cardiovascular disease, as well as some cancers. People who are not active are twice as likely to develop heart and cardiovascular disease compared to those who are more active. The more overweight you are, the higher your risk for heart disease. More research with lesbians in this area is needed.
• Obesity. Being obese can make you more likely to get heart disease, and cancers of the uterus, ovary, breast, and colon. Many studies have found that lesbians have a higher body mass than heterosexual women. Studies suggest that lesbians may store fat more in the abdomen and have a greater waist circumference, which places them at higher risk for heart disease and other obesity-related issues such as premature death. Additionally, some suggest that lesbians are less concerned about weight issues than heterosexual women.
  
  At this time, more research is needed in these areas: physical activity in lesbians; possible dietary differences between lesbians and heterosexual women; if a higher BMI is a reflection of lean tissue and not excess fat; and if there’s a different cultural norm among lesbians about thinness. In addition, other important factors for researchers to consider are race/ethnic background, age, health status, education, cohabitation with a female relationship partner, and having a disability. Studies have reported that among lesbian and bisexual women, African American or Latina ethnicity, older age, poorer health status, lower educational attainment, lower exercise frequency, and cohabiting with a female relationship partner increases a lesbian woman’s likelihood of having a higher BMI.

• Nutrition. Research supports that lesbian and bisexual women are less likely to eat fruits and vegetables every day. More research on food consumption and dietary differences in relation to health and lesbians and bisexuals is needed.
• Smoking. Smoking can lead to heart disease and multiple cancers, including cancers of the lung, throat, stomach, colon, and cervix. Lesbians are more likely to smoke, compared to heterosexual women. Researchers think that high rates of smoking in this population are a consequence several things, like social factors, such as low self-esteem, stress resulting from discrimination, concealing one’s sexual orientation, and tobacco advertising targeted towards gays and lesbians. Studies have also found that smoking rates are higher among gay and lesbian adolescents compared to the general population. Smoking as a teen increases the risk of becoming an adult smoker. We know that about 90 percent of adult smokers started smoking as teens.
• Depression and Anxiety. Many factors cause depression and anxiety among all women. Studies show that lesbian and bisexual women report higher rates of depression and anxiety than heterosexual women do. This may result from the fact that lesbian women may also face:
• Social stigma
• Rejection by family members
• Abuse and violence
• Being treated unfairly in the legal system
• Hiding some or all aspects of one’s life
• Lacking health insurance

Lesbians often feel they have to conceal their lesbian status to family, friends, and employers. Lesbians can also be recipients of hate crimes and violence. Despite strides in our larger society, discrimination against lesbians does exist, and discrimination for any reason may lead to depression and anxiety.

• Alcohol and drug abuse. Substance abuse is as serious a public health problem for the lesbians, gay men, bisexuals, and transgendered people (LGBT) as it is for the general U.S. population. Overall, recent data suggest that substance use among lesbians — particularly alcohol use — has declined over the past two decades. Reasons for this decline may include greater awareness and concern about health; more moderate drinking among women in the general population; some lessening of the social stigma and oppression of lesbians; and changing norms associated with drinking in some lesbian communities. However, both heavy drinking and use of drugs other than alcohol appear to be prevalent among young lesbians and among some older groups of lesbians.
• Cancers. Lesbian women may be at a higher risk for uterine, breast, cervical, endometrial, and ovarian cancers because of the health profiles listed above. However, more research is needed. In addition, these reasons may contribute to this risk:
• Lesbians have traditionally been less likely to bear children. Hormones released during pregnancy and breastfeeding are believed to protect women against breast, endometrial, and ovarian cancers.
• Lesbians have higher rates of alcohol use, poor nutrition, and obesity. These factors may increase the risk of breast, endometrial, and ovarian cancers, and other cancers.
• Lesbians are less likely to visit a doctor or nurse for routine screenings, such as a Pap, which can prevent or detect cervical cancer. The viruses that cause most cervical cancer can be sexually transmitted between women. Lesbians have similar rates of mammography testing (for breast cancer) as heterosexual women.
• Domestic Violence. Also called intimate partner violence, this is when one person purposely causes either physical or mental harm to another. Domestic violence can occur in lesbian relationships as it does in heterosexual relationships, though there is some evidence that it occurs less often. But for many reasons, lesbian victims are more likely to stay silent about the violence. Some reasons include fewer services available to help them; fear of discrimination; threats from the batterer to “out” the victim; or fear of losing custody of children.
• Polycystic Ovarian Syndrome. PCOS is the most common hormonal reproductive problem in women of childbearing age. PCOS is a health problem that can affect a woman’s menstrual cycle, fertility, hormones, insulin production, heart, blood vessels, and appearance. Women with PCOS have these characteristics:
• high levels of male hormones, also called androgens
• an irregular or no menstrual cycle
• may or may not have many small cysts in their ovaries. Cysts are fluid- filled sacs.

An estimated five to 10 percent of women of childbearing age have PCOS (ages 20-40). There is evidence that lesbians may have a higher rate of PCOS than heterosexual women.

• Osteoporosis. Millions of women already have or are at risk for osteoporosis. Osteoporosis means that your bones get weak, and you’re more likely to break a bone. Osteoporosis in lesbian women has not yet been well studied.
• Sexual Health. Lesbian women are at risk for many of the same STIs as heterosexual women. Lesbian women can transmit STIs to each other through skin-to-skin contact, mucosa contact, vaginal fluids, and menstrual blood. Sharing sex toys is another method of transmitting STIs. These are common STIs that can be passed between women:
• Bacterial vaginosis (BV). Although we don’t know for sure that BV is caused by a sexually transmitted agent, BV occurs more commonly among women who have recently acquired other STI’s, or who have recently had unprotected sex. For reasons that are unclear, BV is more common in lesbian and bisexual women than heterosexual women, and frequently occurs in both members of lesbian couples. BV happens when the normal bacteria in the vagina get out of balance. Sometimes, BV causes no symptoms, but over half of affected women have a vaginal discharge with a fishy odor or vaginal itching. If left untreated, BV can increase a woman’s chances of getting other STIs such as HIV, chlamydia, gonorrhea, and pelvic inflammatory disease.
• Human papillomavirus (HPV). HPV can cause genital warts and abnormal changes on the cervix that can lead to cancer, if it is not treated. Most people with HPV or genital warts don’t know they are infected until they have had a Pap test because they may not have symptoms, but the virus can still be spread by contact. Lesbians can transmit HPV through direct genital skin-to-skin contact or by the virus traveling on hands or sex toys. Some women and their doctors wrongly assume that lesbian women do not need a regular Pap test. However, the virus can be spread by lesbian sexual activity, and many lesbians have been sexual with men so it is recommended that lesbian women have a Pap test. This simple test is an effective method of detecting abnormal cells on the cervix that can lead to cancer. Begin getting Pap tests no later than age 21 or sooner if you’re sexually active. These recommendations apply equally to lesbians who’ve never had sex with men, as cervical cancer caused by HPV has been seen in this group of women.
• Trichomoniasis “Trich”. It is caused by a parasite that can be passed from one person to another during sexual contact. It can also be picked up from contact with damp, moist objects such as towels or wet clothing. Trich is spread through sexual contact with an infected person. Signs include yellow, green, or gray vaginal discharge (often foamy) with a strong odor; discomfort during sex and when urinating; irritation and itching of the genital area; and lower abdominal pain in rare cases. To tell if you have trich, your doctor or nurse will do a pelvic exam and lab test. A pelvic exam can show small red sores, or ulcerations, on the wall of the vagina or on the cervix. Trich is treated with antibiotics.
• Herpes. Herpes is a virus that can produce sores (also called lesions) in and around the vaginal area, on the penis, around the anal opening, and on the buttocks or thighs. Occasionally, sores also appear on other parts of the body where the virus has entered through broken skin. Most people get genital herpes by having sex with someone who is shedding the herpes virus during periods when an outbreak is not visible. The most common cause of recurrent genital herpes is HSV-2, which is transmitted through direct genital contact. HSV-1 is another herpes virus that usually infects the mouth and causes oral cold sores, but can also be transmitted to the genital area through oral sex. Lesbians can transmit this virus to each other if they have intimate contact with someone with a lesion or touching infected skin even when an outbreak is not visible.
• Syphilis. Syphilis is an STI caused by bacteria. Syphilis is passed through direct contact with a syphilis sore during vaginal, anal, or oral sex. If untreated, syphilis can infect other parts of the body. Syphilis remains uncommon in the general population, but has been increasing in men who have sex with men. It is extremely rare among lesbians. However, lesbians should talk to their doctor if they have any non-healing ulcers.

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What other STIs can lesbian women get?

Symptoms Of STIs

STI	Symptoms
Chlamydia	Most women have no symptoms. Women with symptoms may have: abnormal vaginal discharge burning when urinating bleeding between menstrual periods Infections that are not treated, even if there are no symptoms, can lead to: lower abdominal pain low back pain nausea fever pain during sex bleeding between periods
Gonorrhea	Symptoms are often mild, but most women have no symptoms. Even when women have symptoms, they can sometimes be mistaken for a bladder or other vaginal infection. Symptoms are: pain or burning when urinating yellowish and sometimes bloody vaginal discharge bleeding between menstrual periods
Hepatitis B	Some women have no symptoms. Women with symptoms may have: mild fever headache and muscle aches tiredness loss of appetite nausea or vomiting diarrhea dark-colored urine and pale bowel movements stomach pain skin and whites of eyes turning yellow
HIV/AIDS	Some women may have no symptoms for 10 years or more. Women with symptoms may have: extreme fatigue rapid weight loss frequent low-grade fevers and night sweats frequent yeast infections (in the mouth) vaginal yeast infections and other STIs pelvic inflammatory disease (PID) menstrual cycle changes red, brown, or purplish blotches on or under the skin or inside the mouth, nose, or eyelids
Pubic Lice	itching finding lice

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What can lesbian women do to protect their health?

• Find a doctor who is sensitive to your needs to help you get regular check ups. The Gay and Lesbian Medical Association provides online health care referrals. You can access their database of members at www.glma.org/programs/prp/index.shtml or contact them at (415) 255-4547.
• Get a Pap test. The Pap test finds changes in your cervix early, so you can be treated before the problem becomes serious. Begin getting Pap tests no later than age 21 or within three years of first having sexual intercourse. After two to three yearly Pap tests have been normal, talk to your doctor or nurse about getting a Pap test at least once every three years.
• Talk to your doctor or nurse about an HPV test if your Pap test is abnormal. In combination with a Pap test, an HPV test helps prevent cervical cancer. It can detect the types of HPV that cause cervical cancer. The Food and Drug Administration (FDA) has approved an HPV DNA test for women for the following uses:
• as a follow-up to a Pap test with results that are abnormal
• in combination with a Pap test in women aged 30 and older
• Practice safer sex. Get tested for STI’s like chlamydia or herpes before beginning a relationship. If you’re unsure about a partner’s status, practice methods to reduce the likelihood of sharing vaginal fluid or blood, including condoms on sex toys.
• Have a balanced, healthy diet. Eat a variety of whole grains, fruits, and vegetables. These foods give you energy, plus vitamins, minerals, and fiber. Besides, they taste good! Try foods like brown rice or whole-wheat bread. Bananas, strawberries, and melons are some great tasting fruits. Try vegetables raw, on a sandwich, or in a salad. Be sure to pick a variety of colors and kinds of fruits and vegetables. You can vary the form — try fresh, frozen, canned, or dried. Read more about eating healthy in our FAQ on Heart Healthy Eating.
• Drink moderately. If you drink alcohol, don’t have more than one drink per day. Too much alcohol raises blood pressure and can raise your risk for stroke, heart disease, osteoporosis, many cancers, and other problems.
• Get moving. An active lifestyle can help every woman. Thirty minutes of moderate physical activity on most days of the week can greatly improve your health and decrease your risk of heart disease and some cancers!
• Don’t smoke. If you do smoke, try to quit. Avoid second hand smoke as much as you can. Read more about quitting at http://www.womenshealth.gov/quit-smoking.
• Try different strategies to deal with your stress. Stress from discrimination is a tough challenge in the life of every lesbian. Relax using deep breathing, yoga, meditation, and massage therapy. You can also take a few minutes to sit and listen to soothing music, or read a book. Talk to your friends or get help from a professional if you need it.
• Talk to your doctor or nurse about screening tests you may need. Regular preventive screenings are critical to staying healthy. All the tests that heterosexual women need, lesbian women need too. See these online charts for screening guidelines for different age groups:http://www.womenshealth.gov/prevention.
• Get help for domestic violence. Call the police or leave if you or your children are in danger! Call a crisis hotline or the National Domestic Violence Hotline at 800-799-SAFE or TDD 800-787-3224, which is available 24 hours a day, 365 days a year, in English, Spanish, and other languages. The Helpline can give you the phone numbers of local hotlines and other resources.
• Build strong bones. Exercise. Get a bone density test. Learn more about that at: osteoporosis.cfm. Make sure you get enough calcium and vitamin D each day. Reduce your chances of falling by making your home safer. For example, use a rubber bathmat in the shower or tub. Keep your floors free from clutter. Lastly, talk to your doctor or nurse about taking medicines to prevent or treat bone loss.
• Know the Signs of a Heart Attack. Women are less likely than men to believe they are having a heart attack and more likely to delay in seeking treatment. For women, chest pain may not be the first sign your heart is in trouble. Before a heart attack, women have said that they have unusual tiredness, trouble sleeping, problems breathing, indigestion, and anxiety. These symptoms can happen a month or so before the heart attack. During a heart attack, women often have these symptoms:
• Pain or discomfort in the center of the chest.
• Pain or discomfort in other areas of the upper body, including the arms, back, neck, jaw, or stomach.
• Other symptoms, such as shortness of breath, breaking out in a cold sweat, nausea, or light-headedness.

• Know the Signs of a Stroke. The signs of a stroke happen suddenly and are different from the signs of a heart attack. Signs you should look for are weakness or numbness on one side of your body, dizziness, loss of balance, confusion, trouble talking or understanding speech, headache, nausea, or trouble walking or seeing. Remember: Even if you have a “mini-stroke,” you may have some of these signs.

Mammograms

What is a mammogram?

A mammogram is a safe, low-dose x-ray exam of the breasts to look for changes that are not normal. The results are recorded on x-ray film or directly into a computer for a doctor called a radiologist to examine.

A mammogram allows the doctor to have a closer look for changes in breast tissue that cannot be felt during a breast exam. It is used for women who have no breast complaints and for women who have breast symptoms, such as a change in the shape or size of a breast, a lump, nipple discharge, or pain. Breast changes occur in almost all women. In fact, most of these changes are not cancer and are called “benign,” but only a doctor can know for sure. Breast changes can also happen monthly, due to your menstrual period.

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What is the best method of detecting breast cancer as early as possible?

A mammogram plus a clinical breast exam, an exam done by your doctor, is the most effective way to detect breast cancer early. Finding breast cancer early greatly improves a woman’s chances for successful treatment.

Like any test, mammograms have both benefits and limitations. For example, some cancers can't be found by a mammogram, but they may be found in a clinical breast exam.

Checking your own breasts for lumps or other changes is called a breast self-exam (BSE). Studies so far have not shown that BSE alone helps reduce the number of deaths from breast cancer. BSE should not take the place of routine clinical breast exams and mammograms.

If you choose to do BSE, remember that breast changes can occur because of pregnancy, aging, menopause, menstrual cycles, or from taking birth control pills or other hormones. It is normal for breasts to feel a little lumpy and uneven. Also, it is common for breasts to be swollen and tender right before or during a menstrual period. If you notice any unusual changes in your breasts, contact your doctor.

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How is a mammogram done?

You stand in front of a special x-ray machine. The person who takes the x-rays, called a radiologic technician, places your breasts, one at a time, between an x-ray plate and a plastic plate. These plates are attached to the mammogram machine and compress the breasts to flatten them. This spreads the breast tissue out to obtain a clearer picture. You will feel pressure on your breast for a few seconds. It may cause you some discomfort; you might feel squeezed or pinched. This feeling only lasts for a few seconds, and the flatter your breast, the better the picture. Most often, two pictures are taken of each breast — one from the side and one from above. A screening mammogram takes about 20 minutes from start to finish.

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Are there different types of mammograms?

• Screening mammograms are done for women who have no symptoms of breast cancer. It usually involves two x-rays of each breast. Screening mammograms can detect lumps or tumors that cannot be felt. They can also find microcalcifications (my-kro-kal-si-fi-KAY-shuns) or tiny deposits of calcium in the breast, which sometimes mean that breast cancer is present.
• Diagnostic mammograms are used to check for breast cancer after a lump or other symptom or sign of breast cancer has been found. Signs of breast cancer may include pain, thickened skin on the breast, nipple discharge, or a change in breast size or shape. This type of mammogram also can be used to find out more about breast changes found on a screening mammogram, or to view breast tissue that is hard to see on a screening mammogram. A diagnostic mammogram takes longer than a screening mammogram because it involves more x-rays in order to obtain views of the breast from several angles. The technician can magnify a problem area to make a more detailed picture, which helps the doctor make a correct diagnosis.

A digital mammogram also uses x-ray radiation to produce an image of the breast, but instead of storing the image directly on film, it stores the image of the breast directly on a computer. This allows the recorded data to be magnified for the doctor to take a closer look. Current research has not shown that digital images are better at showing cancer than x-ray film images in general. But, women with dense breasts who are pre- or perimenopausal, or who are younger than age 50, may benefit from having a digital rather than a film mammogram. Digital mammography may offer these benefits:

• Long-distance consults with other doctors may be easier because the images can be shared by computer.
• Slight differences between normal and abnormal tissues may be easily noted.
• The number of follow-up tests needed may be fewer.
• Fewer repeat images may be needed, reducing exposure to radiation.

How often should I get a mammogram?

• Women 40 years and older should get a mammogram every 1-2 years.
• Women who have had breast cancer or other breast problems or who have a family history of breast cancer might need to start getting mammograms before age 40, or they might need to get them more often. Talk to your doctor about when to start and how often you should have a mammogram.

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What can mammograms show?

The radiologist will look at your x-rays for breast changes that do not look normal and for differences in each breast. He or she will compare your past mammograms with your most recent one to check for changes. The doctor will also look for lumps and calcifications.

• Lump or mass. The size, shape, and edges of a lump sometimes can give doctors information about whether or not it may be cancer. On a mammogram, a growth that is benign often looks smooth and round with a clear, defined edge. Breast cancer often has a jagged outline and an irregular shape.
• Calcification. A calcification is a deposit of the mineral calcium in the breast tissue. Calcifications appear as small white spots on a mammogram. There are two types:
  • Macrocalcifications are large calcium deposits often caused by aging. These usually are not a sign of cancer.
  • Microcalcifications are tiny specks of calcium that may be found in an area of rapidly dividing cells.

If calcifications are grouped together in a certain way, it may be a sign of cancer. Depending on how many calcium specks you have, how big they are, and what they look like, your doctor may suggest that you have other tests. Calcium in the diet does not create calcium deposits, or calcifications, in the breast.

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What if my screening mammogram shows a problem?

If you have a screening test result that suggests cancer, your doctor must find out whether it is due to cancer or to some other cause. Your doctor may ask about your personal and family medical history. You may have a physical exam. Your doctor also may order some of these tests:

• Diagnostic mammogram, to focus on a specific area of the breast
• Ultrasound, or imaging test that uses a device with sound waves to create a picture of your breast. The pictures may show whether a lump is solid or filled with fluid. A cyst is a fluid-filled sac. Cysts are not cancer. But a solid mass may be cancer. After the test, your doctor can store the pictures on video or print them out. This exam may be used along with a mammogram.
• Magnetic resonance imaging (MRI), which uses a powerful magnet linked to a computer. MRI makes detailed pictures of breast tissue. Your doctor can view these pictures on a monitor or print them on film. MRI may be used along with a mammogram.
• Biopsy, a test in which fluid or tissue is removed from your breast to help find out if there is cancer. Your doctor may refer you to a surgeon or to a doctor who is an expert in breast disease for a biopsy.

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Where can I get a high-quality mammogram?

Women can get high quality mammograms in breast clinics, hospital radiology departments, mobile vans, private radiology offices, and doctors’ offices. The Food and Drug Administration (FDA) certifies mammography facilities that meet strict quality standards for their x-ray machines and staff and are inspected every year. You can ask your doctor or the staff at the mammography center about FDA certification before making your appointment. A list of FDA-certified facilities can be found on the Internet at: http://www.fda.gov/cdrh/mammography/certified.html.

Your doctor, local medical clinic, or local or state health department can tell you where to get no-cost or low-cost mammograms. You can also call the National Cancer Institute's Cancer Information Service toll free at 1-800-422-6237 (TTY: 1-800-332-8615). Visit them online at http://www.cancer.gov.

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What if I have breast implants?

Women with breast implants should continue to have mammograms. A woman who had an implant after breast cancer surgery should ask her doctor whether she needs a mammogram of the reconstructed breast.

If you have breast implants, be sure to tell your mammography facility that you have them when you make your appointment. The technician and radiologist must be experienced in x-raying patients with breast implants. Implants can hide some breast tissue, making it harder for the radiologist to see a problem when looking at your mammogram. To see as much breast tissue as possible, the x-ray technician will gently lift the breast tissue slightly away from the implant and take extra pictures of the breasts.

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How do I get ready for my mammogram?

First, check with the place you are having the mammogram for any special instructions you may need to follow before you go. Here are some general guidelines to follow:

• If you are still having menstrual periods, try to avoid making your mammogram appointment during the week before your period. Your breasts will be less tender and swollen. The mammogram will hurt less and the picture will be better. 
• If you have breast implants, be sure to tell your mammography facility that you have them when you make your appointment.
• Wear a shirt with shorts, pants, or a skirt. This way, you can undress from the waist up and leave your shorts, pants, or skirt on when you get your mammogram.
• Don't wear any deodorant, perfume, lotion, or powder under your arms or on your breasts on the day of your mammogram appointment. These things can make shadows show up on your mammogram.
• If you have had mammograms at another facility, have those x-ray films sent to the new facility so that they can be compared to the new films.

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Are there any problems with mammograms?

Although they are not perfect, mammograms are the best method to find breast changes. If your mammogram shows a breast change, sometimes other tests are needed to better understand it. Even if the doctor sees something on the mammogram, it does not mean it is cancer.

As with any medical test, mammograms have limits. These limits include:

• They are only part of a complete breast exam. Your doctor also should do a clinical breast exam. If your mammogram finds something abnormal, your doctor will order other tests.
• Finding cancer does not always mean saving lives. Even though mammography can detect tumors that cannot be felt, finding a small tumor does not always mean that a woman’s life will be saved. Mammography may not help a woman with a fast growing cancer that has already spread to other parts of her body before being found.
• False negatives can happen. This means everything may look normal, but cancer is actually present. False negatives don't happen often. Younger women are more likely to have a false negative mammogram than are older women. The dense breasts of younger women make breast cancers harder to find in mammograms.
• False positives can happen. This is when the mammogram results look like cancer is present, even though it is not. False positives are more common in younger women, women who have had breast biopsies, women with a family history of breast cancer, and women who are taking estrogen, such as hormone replacement therapy.
• Mammograms (as well as dental x-rays and other routine x-rays) use very small doses of radiation. The risk of any harm is very slight, but repeated x-rays could cause problems. The benefits nearly always outweigh the risk. Talk to your doctor about the need for each x-ray. Ask about shielding to protect parts of the body that are not in the picture. You should always let your doctor and the technician know if there is any chance that you are pregnant.

Oral Health

What is oral health?

Good oral health does not just mean you have pretty teeth. Your whole mouth needs care to be in good health. The word “oral” refers to the mouth, which includes your teeth, gums, jawbone, and supporting tissues. Taking good care of your oral health can prevent disease in your mouth. Oral health can also affect the health of your body. It is easy to take your oral health for granted. But good oral health is key to your overall health.

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How might problems in your mouth be linked to health problems in other parts of your body?

The health of your mouth can be a sign of your body’s health. Mouth problems are not just cavities, toothaches, and crooked or stained teeth. Many diseases, such as diabetes, HIV, cancer, and some eating disorders, can cause oral health problems. For instance, people with diabetes can develop tooth and gum problems if their blood sugar stays high. Regular dental exams help you maintain good oral health and avoid related health problems.

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What are the most common oral health problems?

The most common oral health problems are cavities and gum disease.

Dental cavities

We are all at risk of tooth decay, or cavities. Bacteria (germs) that naturally live in our mouths use sugar in food to make acids. Over time, the acids destroy the outside layer of your teeth. Then holes and other tooth damage occur.

Gum diseases

Gum diseases are infections caused by bacteria, along with mucus and other particles that form a sticky plaque on your teeth. Plaque that is left on teeth hardens and forms tartar. Gingivitis (jin-juh-VEYE-tuhss) is a mild form of gum disease. It causes red, swollen gums. It can also make the gums bleed easily. Gingivitis can be caused by plaque buildup. And the longer plaque and tartar stay on teeth, the more harm they do. Most gingivitis can be treated with daily brushing and flossing and regular cleanings at the dentist’s office. This form of gum disease does not lead to loss of bone or tissue around the teeth. But if it is not treated, it can advance to periodontitis (pair-ee-oh-don-TEYE-tuhss). Then the gums pull away from the teeth and form infected “pockets.” You may also lose supporting bone. If you have periodontitis, see your dentist for treatment. Otherwise your teeth may loosen over time and need to be removed.

Your risk of gum disease is higher if you:

• smoke
• have a disease such as diabetes or HIV/AIDS

Normal, healthy gums Healthy gums and bone anchor teeth firmly in place.	Periodontitis Plaque left on teeth hardens into tartar. As plaque and tartar build up, the gums pull away from the teeth and pockets form between the teeth and gums. Bone supporting the teeth may get infected and start to weaken.	Advanced periodontitis The gums recede further, destroying more bone and the ligament around the tooth. Teeth may become loose and need to be removed.

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What are some other problems I might have with my mouth?

Burning mouth. People with this condition describe a burning feeling in the mouth or tongue. It is most common in postmenopausal women. The cause is unknown, but might be linked to:

• hormones
• dry mouth
• taste problems
• nutritional deficiencies
• use of ACE inhibitors (blood pressure medicines)

Talk to your doctor or dentist if you have burning mouth. Treatment depends on the cause—if it can be determined—and might include menopausal hormone therapy, vitamin supplements, or pain or other medicines.

Cold sores. These small, painful sores are caused by herpes simplex virus type 1. Once you are exposed to the virus, it can hide in your body for years. Things that trigger the virus and lead to cold sores include:

• getting too much sun
• having a cold or infection
• having your period
• feeling stressed

Cold sores can spread from person to person. They most often form on the lips and sometimes under the nose or chin. The sores heal in about 7 to 10 days without scarring. You can buy over-the-counter drugs to put on cold sores to help relieve pain. If you get cold sores a lot, talk with your doctor or dentist about a prescription for an antiviral drug. These drugs can help reduce healing time and the number of new sores.

Canker sores. These sores are small ulcers inside the mouth. They have a white or gray base and a red border. Women are more likely than men to have canker sores that recur. The cause of canker sores is unknown. Risk factors include:

• fatigue
• stress
• your period
• a cut on the inside of your cheek or on your tongue
• allergies
• celiac disease
• Crohn’s disease

Canker sores most often heal on their own in 1 to 3 weeks. See your dentist if you get a large sore (larger than a half inch). You may need medicine to treat it.

To help with pain:

• avoid hot, spicy foods
• use mild mouthwashes or salt water
• try over-the-counter coatings or pain medicines

No proven way exists to prevent canker sores. If you get them often, talk with your dentist.

Thrush, called oral candidiasis (kan-dih-DEYE-uh-suhss). These fungal infections appear as red or white lesions, flat or slightly raised, in the mouth or throat. They can be caused by overgrowth of the fungusCandida. This fungus lives naturally in your mouth. Your risk of getting thrush increases if:

• you have a weak immune system
• you don’t make enough saliva
• you take antibiotics

Treatment includes antifungal mouthwash or lozenges. If the infection spreads or your immune system is weak, you may need antifungal medicine.

Thrush is common among:        

• denture wearers
• people who are very young or elderly
• people with dry mouth

If you wear dentures, clean and remove them at bedtime. Talk with your dentist about medicines that may be helpful if you have thrush.

Dry mouth, called xerostomia (ZEER-oh-STOM-mee-uh). This problem happens when you don’t have enough saliva in your mouth. Some reasons why people get dry mouth include:

• side effect of medicines or medical treatment
• health problems, such as saliva and salivary gland disorders and rheumatoid arthritis
• blockage of a salivary gland

Dry mouth may make it hard to eat, swallow, taste, and speak. If left untreated, it can lead to cavities. This is because saliva helps rid your mouth of bits of food and helps stop acid from forming plaque on your teeth. Treatment of dry mouth depends on the cause and can range from medicines to diet changes. To lessen the dryness, use artificial saliva, suck on sugarless candy, and use a humidifier.

Bad breath, called halitosis (hal-lih-TOH-suhss). Bad-smelling breath can be caused by several things, including:

• poor oral hygiene
• some foods
• dentures
• gum disease
• dry mouth
• tobacco use
• respiratory, digestive, or other health problems
• some medicines

Practicing good oral hygiene and avoiding tobacco and some foods often helps people with bad-smelling breath. But if doing so doesn’t seem to help or if you always need mouthwash to hide bad breath, talk to your dentist.

Oral cancer. This cancer can affect any part of the mouth. If you smoke or chew tobacco, you are at higher risk. Alcohol use along with smoking raises your risk even more. Yet more than 25 percent of oral cancer affects nonsmokers.

Oral cancer most often occurs after age 40. It isn’t always painful. So it may go undetected until the late stages. Ask your doctor to check for signs of oral cancer during your regular checkup. Oral cancer often starts as a tiny white or red spot or sore anywhere in the mouth. Other signs include:

• a sore that bleeds easily or does not heal
• a color change in the mouth
• a lump, rough spot, or other change
• pain, tenderness, or numbness anywhere in the mouth or on the lips
• problems chewing, swallowing, speaking, or moving the jaw or tongue
• a change in the way the teeth fit together

Oral problems from cancer therapies. Treatments such as chemotherapy or radiation to the head and neck can cause dry mouth, tooth decay, painful mouth sores, and cracked, peeling lips. Get a complete dental exam before starting cancer treatment.

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As a woman, why do I have to worry about oral health?

Everyone needs to take care of their oral health. But female hormones can lead to an increase in some problems, such as:

• cold sores and canker sores
• dry mouth
• changes in taste
• higher risk of gum disease

Taking good care of your teeth and gums can help you avoid or lessen oral health problems.

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I’m pregnant. Do I need to take special care of my mouth?

Yes! If you are pregnant, you have special oral health needs.

Before you become pregnant, it is best to have dental checkups every 6 months. You want to keep your mouth in good health before your pregnancy.

If you are pregnant and have not had regular checkups:

• Have a complete oral exam early in your pregnancy. Because you are pregnant, your dentist might not take routine x-rays. But if you need x-rays, the health risk to your unborn baby is small.
• Remember dental work during pregnancy is safe. The best time for treatment is between the 14th and 20th weeks. In the last months, you might be uncomfortable sitting in a dental chair.
• Have all needed dental treatments. If you avoid treatment, you may risk your and your baby’s health.
• Use good oral hygiene to control your risk of gum diseases. Pregnant women may have changes in taste and develop red, swollen gums that bleed easily. This condition is called pregnancy gingivitis. Both poor oral hygiene and higher hormone levels can cause pregnancy gingivitis. Until now, it was thought that having gum disease could raise your risk of having a low-birth-weight baby. Researchers have not been able to confirm this link, but studies are still under way to learn more.

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I’m a new mother. What can I do for my baby’s oral health?

You can do a lot! Below are some things you need to know about your baby’s oral health.

• The same germs that cause tooth decay in your mouth can be passed to your baby. Do not put your baby’s items, such as toys, spoons, bottles, or pacifiers in your mouth.
• Wipe your baby’s teeth and gums with a clean gauze pad or baby toothbrush after each nursing and feeding. This can help remove sugars found in milk that can cause tooth decay.  
• If you bottle-feed your baby, try to finish bottle weaning by age 1. Avoid giving your baby bottles or pacifiers at naps and bedtime. Sucking on a bottle when lying down can harm your baby’s teeth.
• All babies should visit a dentist by age 1. The dentist will screen for problems in your baby’s mouth. You will also be shown how to care for your child’s teeth and mouth.
• Talk with your doctor about the best water choices for infants. Fluoride is good for teeth. But too much fluoride can harm development of tooth enamel in infants.

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I’m confused! What type of toothpaste or mouthwash should I use?

Many types of toothpastes line the store shelves. Some say they’re made for whitening, others for reducing gingivitis and plaque, and others for sensitive teeth. Before choosing toothpaste for your family, know the basics.

• As long as toothpaste contains fluoride and its box has the American Dental Association’s (ADA) seal of acceptance, it is good for your oral health. Beyond that, choosing toothpastes is a personal choice.
  
• Mouthwashes claim to freshen your breath. But they really only mask breath odor for a few hours. If you always need to use a mouthwash to hide bad breath, see your dentist.

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I’m not happy with the stains on my teeth. How can I safely whiten them?

Safe whitening options vary in price and how well they work:

• Chairside bleaching or “power bleaching.” In your dentist’s office, he or she applies a gel or rubber shield to protect your gums and oral tissues. Then bleach is put on your teeth. Ask if the bleaching agents have the ADA seal. A special light or a laser may be used to help the bleach work better. But no products that use lasers are accepted right now by the ADA. With this method you may have to go for more than one visit. You will see results right away (about five shades brighter). It works well on a range of stains.
• Dentist-dispensed and over-the-counter bleaching products. These products are for home use. They contain peroxide(s), which bleach the tooth enamel. Most come in a gel and are placed in a mouth guard or tray that fits inside your mouth. How long you use them depends on the results you’re looking for and if you are sensitive to the bleach. Some products are used twice a day for 2 weeks, and others are used overnight for 1 to 2 weeks. They help many types of staining. Your teeth turn about six shades brighter with long-lasting results. But only the dentist-dispensed solutions have the ADA seal.
• Over-the-counter whitening products. These products are for home use and include whitening strips, paint-on products, gels, and trays. They have a low amount of peroxide. You wear some during the day and apply some at night before bedtime.  They can help staining due to age and certain foods. Your teeth turn about two shades brighter for up to 6 months. For better results, have a cleaning at the dentist before you use these products. These gels and trays do not have the ADA seal.
• Whitening toothpastes. All toothpastes help remove surface stain through mild abrasives. "Whitening" toothpastes that have the ADA seal have special polishing agents that remove even more stains. Unlike bleaches, these products do not change the actual color of teeth. They help surface stains only. You might see short-term results that are one to two shades brighter.

Products used to whiten teeth can make teeth more sensitive. They can also bother your gums. These side effects most often go away after you stop using the product.

Before using whitening products, talk with your dentist. He or she can help you decide which method is best for the type of stains on your teeth. Not all products work on all people. Options offered by your dentist can be expensive, so ask your dentist to fully explain the results you can really expect. Keep in mind that whitening your teeth does not make your mouth any healthier. 

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What small, easy steps can I take to have a healthy smile?

1. Brush your teeth at least twice each day with fluoride toothpaste. Aim for first thing in the morning and before going to bed. Once a day, use floss or an interdental cleaner to clean food your toothbrush missed.

Make sure you:

• Drink water that contains added fluoride if you can. Fluoride protects against dental decay. Most public water systems in the United States have added fluoride. Check with your community’s water or health department to find out if there is fluoride in your water. You also may want to use a fluoride mouth rinse, along with brushing and flossing, to help prevent tooth decay.
• Gently brush all sides of your teeth with a soft-bristled brush. Round and short back-and-forth strokes work best.
• Take time to brush along the gum line, and lightly brush your tongue to help remove plaque and food.
• Ask your dentist or dental hygienist to show you the best way to floss your teeth.
• Change your toothbrush every 3 months, or earlier if the toothbrush looks worn or the bristles spread out. A new toothbrush removes more plaque.
• If you wear dentures, be sure to remove them at night and clean them before putting them back in the next morning.

2. Have a healthy lifestyle.

• Eat healthy meals. Cut down on tooth decay by brushing after meals. Avoid snacking on sugary or starchy foods between meals.
• Don’t smoke. It raises your risk of gum disease, oral and throat cancers, and oral fungal infections. It also affects the color of your teeth and the smell of your breath.
• Limit alcohol use to one drink per day for women. Heavy alcohol use raises your risk of oral and throat cancers. Using alcohol and tobacco together raises your risk of oral cancers more than using one alone.
• Limit how much of soda you drink. Even diet soda contains acids that can erode tooth enamel.

3. Get regular checkups.

• Have an oral exam once or twice a year. Your dentist may recommend more or fewer visits depending on your oral health. At most routine visits, the dentist and a dental hygienist will treat you. During regular checkups, dentists look for signs of diseases, infections, problems, injuries, and oral cancer.
• See your dentist right away if
• your gums bleed often
• you see any red or white patches on the gums, tongue, or floor of the mouth
• you have mouth or jaw pain that won’t go away
• you have sores that do not heal within 2 weeks
• you have problems swallowing or chewing
• Besides your dentist, other types of dental providers include:
  • Dental hygienists: Members of the dental staff who clean gums and teeth and teach patients how to maintain good oral health.
  • Periodontists: Dentists who treat gum disease and place dental implants.
  • Oral surgeons: Dentists who operate on your mouth and supporting tissues.
  • Orthodontists: Dentists who straighten teeth and align jaws.
  • Endodontists: Dentists who perform root canals.
  • Prosthodontists: Dentists trained in restoring and replacing teeth.

4. Follow your dentist’s advice. 
Your dentist may suggest ways to keep your mouth healthy. He or she can teach you how to properly floss or brush. Follow any recommended steps or treatments to keep your mouth healthy.

5. If you have another health problem, think about how it may affect your oral health. 
For instance, if you take medicines that give you a dry mouth, ask your doctor or nurse if there are other drugs you can use. Have an oral exam before starting cancer treatment. And if you have diabetes, practice good oral hygiene to prevent gum disease.

Osteoporosis

hat is osteoporosis?

Osteoporosis (OS-tee-oh-poh-ROH-sis) is a disease of the bones. People with osteoporosis have bones that are weak and break easily.

A broken bone can really affect your life. It can cause severe pain and disability. It can make it harder to do daily tasks on your own, such as walking.

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What bones does osteoporosis affect?

Osteoporosis affects all bones in the body. However, breaks are most common in the hip, wrist, and spine, also called vertebrae (VUR-tuh-bray). Vertebrae support your body, helping you to stand and sit up. See the picture below.

Osteoporosis in the vertebrae can cause serious problems for women. A fracture in this area occurs from day-to-day activities like climbing stairs, lifting objects, or bending forward. Signs of osteoporosis: Sloping shoulders Curve in the back Height loss Back pain Hunched posture Protruding abdomen

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What increases my chances of getting osteoporosis?

There are several risk factors that raise your chances of developing osteoporosis. Some of these factors are things you can control, while some you can’t control.

Factors that you can’t control:

• Being female
• Having a small, thin body (under 127 pounds)
• Having a family history of osteoporosis
• Being over 65 years old
• Being white or Asian, but African American and Hispanic/Latina women are also at risk
• Not getting your period (if you should be getting it)
• Having anorexia nervosa
• Not getting enough exercise
• Long-term use of certain medicines, including:
  • Glucocorticoids (GLOO-koh-KOR-ti-koids) — medicines used to treat many illnesses, including arthritis, asthma, and lupus
  • Some antiseizure medicines
  • Gonadotropin (GOH-nad-oo-TROO-pin) -releasing hormone — used to treat endometriosis(en-doh-mee-tree-O-sis)
  • Antacids with aluminum — the aluminum blocks calcium absorption
  • Some cancer treatments
  • Too much replacement thyroid hormone

Factors that you can control

• Smoking
• Drinking too much alcohol. Experts recommend no more than 1 drink a day for women.
• A diet low in dairy products or other sources of calcium and vitamin D
• Not getting enough exercise

You may also develop symptoms that are warning signs for osteoporosis. If you develop the following, you should talk to your doctor about any tests or treatment you many need:

• Loss in height, developing a slumped or hunched posture, or onset of sudden unexplained back pain.
• You are over age 45 or a post-menopausal and you break a bone.

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How can I find out if I have weak bones?

There are tests you can get to find out your bone density. This is related to how strong or fragile your bones are. One test is called dual-energy X-ray absorptiometry (DXA). A DXA scan takes X-rays of your bones. Talk with your doctor or nurse about this. 

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When should I get a bone density test?

If you are age 65 and older, you should get a bone density test. Women age 60 to 64 with risk factors for osteoporosis and women over 45 who have broken any bones should also get tested. If you are age 40 to 60, you should discuss risk factors and testing with your doctor or nurse.

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How can I prevent weak bones?

The best way to prevent weak bones is to work on building strong ones. No matter how old you are, it is never too late to start. Building strong bones during childhood and the teen years is one of the best ways to keep from getting osteoporosis later. As you get older, your bones don’t make new bone fast enough to keep up with the bone loss. And after menopause, bone loss happens more quickly. But there are steps you can take to slow the natural bone loss with aging and to prevent your bones from becoming weak and brittle.

1. Get enough calcium each day.

Bones contain a lot of calcium. It is important to get enough calcium in your diet. You can get calcium through foods and/or calcium pills, which you can get at the grocery store or drug store. Getting calcium through food is definitely better since the food provides other nutrients that keep you healthy. Talk with your doctor or nurse before taking calcium pills to see which kind is best for you. Taking more calcium pills than recommended doesn’t improve your bone health. So, try to reach these goals through a combination of food and supplements.

Here’s how much calcium you need each day.

Daily Calcium Requirments

Ages	Milligrams(mg) per day
9-18	1300
19-50	1000
51 and older	1200

Pregnant or nursing women need the same amount of calcium as other women of the same age.

Here are some foods to help you get the calcium you need. Check the food labels for more information.

Foods Containing Calcium

Food	Portion	Milligrams
Plain, fat free yogurt	1 cup	452
Milk (fat-free)	1 cup	306
Milk (1 percent low-fat)	1 cup	290
Tofu with added calcium	1/2 cup	253
Spinach, frozen	1/2 cup	146
White beans, canned	1/2 cup	106

The calcium amounts of these foods are taken from the United States Department of Agriculture’s Dietary Guidelines for Americans. 

2. Get enough vitamin D each day.

It is also important to get enough vitamin D, which helps your body absorb calcium from the food you eat. Vitamin D is produced in your skin when it is exposed to sunlight. You need 10 to 15 minutes of sunlight to the hands, arms, and face, two to three times a week to make enough vitamin D. The amount of time depends on how sensitive your skin is to light. It also depends on your use of sunscreen, your skin color, and the amount of pollution in the air. You can also get vitamin D by eating foods, such as milk, or by taking vitamin pills. Vitamin D taken in the diet by food or pills is measured in international units (IU). Look at the pill bottle or food label for the IU amount.

Here’s how much vitamin D you need each day: 

Daily Vitamin D Requirements

Ages	IU per day
19-50	200
51-70	400
71+	600

Current research suggests that many people of all ages are not getting enough vitamin D. Some experts think that for good health, daily doses of vitamin D should be higher. Your doctor can help you make a plan for getting enough vitamin D.

Although it’s difficult to get enough vitamin D through food, here are some foods that can help. Check the food labels for more information.

Foods Containing Vitamin D

Food	Portion	IU
Salmon, cooked	3 1/2 oz	360
Milk, vitamin D fortified	1 cup	98
Egg (vitamin D is in the yolk)	1 whole	20

These foods and IU counts are from the National Institutes of Health Office on Dietary Supplements.

White milk is a good source of vitamin D, most yogurts are not.

3. Eat a healthy diet.

Other nutrients (like vitamin K, vitamin C, magnesium, and zinc, as well as protein) help build strong bones too. Milk has many of these nutrients. So do foods like lean meat, fish, green leafy vegetables, and oranges.  

4. Get moving.

Being active helps your bones by:

• Slowing bone loss
• Improving muscle strength
• Helping your balance

Do weight-bearing physical activity, which is any activity in which your body works against gravity. There are many things you can do:

• Walk
• Dance
• Run
• Climb stairs
• Garden
• Jog
• Hike
• Play tennis
• Lift weights
• Yoga
• Tai chi

5. Don’t smoke.

Smoking raises your chances of getting osteoporosis. It harms your bones and lowers the amount ofestrogen in your body. Estrogen is a hormone made by your body that can help slow bone loss.

6. Drink alcohol moderately.

If you drink, don’t drink more than one alcoholic drink per day. Alcohol can make it harder for your body to use the calcium you take in. And, importantly, too much at one time can affect your balance and lead to falls.

7. Make your home safe.

Reduce your chances of falling by making your home safer. Use a rubber bath mat in the shower or tub. Keep your floors free from clutter. Remove throw rugs that may cause you to trip. Make sure you have grab bars in the bath or shower.

8. Think about taking medicines to prevent or treat bone loss.

Talk with your doctor or nurse about the risks and benefits of medicines for bone loss.

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How can I help my daughter have strong bones?

Act now to help her build strong bones to last a lifetime. Girls ages 9-18 are in their critical bone-building years. Best Bones Forever!™ is a national education effort to encourage girls ages 9-14 to eat more foods with calcium and vitamin D and get more physical activity. There is also a Web site for the parents. This site gives parents the tools and information they need to help their daughters build strong bones during the critical window of bone growth — ages 9-18.

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What if dairy foods make me sick or I don’t like to eat them? How can I get enough calcium?

If you’re lactose intolerant, it can be hard to get enough calcium. Lactose is the sugar that is found in dairy products like milk. Lactose intolerance means your body has a hard time digesting foods that contain lactose. You may have symptoms like gas, bloating, stomach cramps, diarrhea, and nausea. Lactose intolerance can start at any age but often starts when you get older.

Lactose-reduced and lactose-free products are sold in food stores. There’s a great variety, including milk, cheese, and ice cream. You can also take pills or liquids before eating dairy foods to help you digest them. You can buy these pills at the grocery store or drug store. Please note: If you have symptoms of lactose intolerance, see your doctor or nurse. These symptoms could also be from a different, more serious illness.

People who are lactose intolerant or who are vegans (eat only plant-based foods) can choose from other food sources of calcium, including canned salmon with bones, sardines, Chinese cabbage, bok choy, kale, collard greens, turnip greens, mustard greens, broccoli, and calcium-fortified orange juice. Some cereals also have calcium added. You can also take calcium pills. Talk to your doctor or nurse first to see which one is best for you.

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Do men get osteoporosis?

Yes. In the U.S., over two million men have osteoporosis. Men over age 50 are at greater risk. So, keep an eye on the men in your life, especially if they are over 70 or have broken any bones.

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How will pregnancy affect my bones?

To grow strong bones, a baby needs a lot of calcium. The baby gets his or her calcium from what you eat (or the supplements you take). In some cases, if a pregnant woman isn’t getting enough calcium, she may lose a little from her bones, making them less strong. So, pregnant women should make sure they are getting the recommended amounts of calcium and vitamin D. Talk to your doctor about how much you should be getting.

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Will I suffer bone loss during breastfeeding?

Although bone density can be lost during breastfeeding, this loss tends to be temporary. Several studies have shown that when women have bone loss during breastfeeding, they recover full bone density within six months after weaning.

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How is osteoporosis treated?

If you have osteoporosis, you may need to make some lifestyle changes and also take medicine to prevent future fractures. A calcium-rich diet, daily exercise, and drug therapy are all treatment options.

These different types of drugs are approved for the treatment or prevention of osteoporosis:

• Bisphosphonates (bis-fos-fo-nates) — Bisphosphonates are approved for both prevention and treatment of postmenopausal osteoporosis. Drugs in this group also can treat bone loss, and in some cases, can help build bone mass.
• SERMs — A class of drugs called estrogen agonists/antagonists, commonly referred to as selective estrogen receptor modulators (SERMs) are approved for the prevention and treatment of postmenopausal osteoporosis. They help slow the rate of bone loss.
• Calcitonin (kal-si-TOE-nin) — Calcitonin is a naturally occurring hormone that can help slow the rate of bone loss.
• Menopausal Hormone Therapy (MHT) — These drugs, which are used to treat menopausal symptoms, also are used to prevent bone loss. But recent studies suggest that this might not be a good option for many women. The Food and Drug Administration (FDA) has made the following recommendations for taking MHT:
  • Take the lowest possible dose of MHT for the shortest time to meet treatment goals.
  • Talk about using other osteoporosis medications instead.
• Parathyroid Hormone or Teriparatide (terr-ih-PAR-a-tyd) — Teriparatide is an injectable form of human parathyroid hormone. It helps the body build up new bone faster than the old bone is broken down.

Your doctor can tell you what treatments might work best for you.

Pap Test

What is a Pap test?

The Pap test, also called a Pap smear, checks for changes in the cells of your cervix. The cervix is the lower part of the uterus (womb) that opens into the vagina (birth canal). The Pap test can tell if you have an infection, abnormal (unhealthy) cervical cells, or cervical cancer.

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Why do I need a Pap test?

A Pap test can save your life. It can find the earliest signs of cervical cancer. If caught early, the chance of curing cervical cancer is very high. Pap tests also can find infections and abnormal cervical cells that can turn into cancer cells. Treatment can prevent most cases of cervical cancer from developing.

Getting regular Pap tests is the best thing you can do to prevent cervical cancer. In fact, regular Pap tests have led to a major decline in the number of cervical cancer cases and deaths.

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Do all women need Pap tests?

It is important for all women to have Pap tests, along with pelvic exams, as part of their routine health care. You need a Pap test if you are 21 years or older.

Women who have gone through menopause (when a woman's periods stop) still need regular Pap tests. Women ages 65 and older can talk to their doctor about stopping after at least 3 normal Pap tests and no abnormal results in the last 10 years.

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How often do I need to get a Pap test?

It depends on your age and health history. Talk with your doctor about what is best for you. Most women can follow these guidelines:

• Starting at age 21, have a Pap test every 2 years.
• If you are 30 years old and older and have had 3 normal Pap tests for 3 years in a row, talk to your doctor about spacing out Pap tests to every 3 years.
• If you are over 65 years old, ask your doctor if you can stop having Pap tests.

Ask your doctor about more frequent testing if:

• You have a weakened immune system because of organ transplant, chemotherapy, or steroid use
• Your mother was exposed to diethylstilbestrol (DES) while pregnant
• You are HIV-positive

Women who are living with HIV, the virus that causes AIDS, are at a higher risk of cervical cancer and other cervical diseases. The U.S. Centers for Disease Control and Prevention recommends that all HIV-positive women get an initial Pap test, and get re-tested 6 months later. If both Pap tests are normal, then these women can get yearly Pap tests in the future.

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Who does not need regular Pap tests?

The only women who do not need regular Pap tests are:

• Women over age 65 who have had 3 normal Pap tests and in a row and no abnormal test results in the last 10 years, and have been told by their doctors that they don't need to be tested anymore.
• Women who do not have a cervix and are at low risk for cervical cancer. These women should speak to their doctor before stopping regular Pap tests.

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I had a hysterectomy. Do I still need Pap tests?

It depends on the type of hysterectomy (surgery to remove the uterus) you had and your health history. Women who have had a hysterectomy should talk with their doctor about whether they need routine Pap tests.

Usually during a hysterectomy, the cervix is removed with the uterus. This is called a total hysterectomy. Women who have had a total hysterectomy for reasons other than cancer may not need regular Pap tests. Women who have had a total hysterectomy because of abnormal cells or cancer should be tested yearly for vaginal cancer until they have three normal test results. Women who have had only their uterus removed but still have a cervix need regular Pap tests. Even women who have had hysterectomies should see their doctors yearly for pelvic exams.

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How can I reduce my chances of getting cervical cancer?

Aside from getting Pap tests, the best way to avoid cervical cancer is by steering clear of the human papillomavirus (HPV). HPV is a major cause of cervical cancer. HPV infection is also one of the most common sexually transmitted infections (STI). So, a woman boosts her chances of getting cervical cancer if she:

• Starts having sex before age 18
• Has many sex partners
• Has sex partners who have other sex partners
• Has or has had a STI

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What should I know about human papillomaviruses (HPV)?

Human papillomaviruses (HPV) are a group of more than 100 different viruses.

• About 40 types of HPV are spread during sex.
• Some types of HPVs can cause cervical cancer when not treated.
• HPV infection is one of the most common sexually transmitted infections (STI).
• About 75 percent of sexually active people will get HPV sometime in their life.
• Most women with untreated HPV do not get cervical cancer.
• Some HPVs cause genital warts but these HPVs do not cause cervical cancer.
• Since HPV rarely causes symptoms, most people don't know they have the infection.

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How would I know if I had human papillomavirus (HPV)?

Most women never know they have HPV. It usually stays hidden and doesn't cause symptoms like warts. When HPV doesn't go away on its own, it can cause changes in the cells of the cervix. Pap tests usually find these changes.

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How do I prepare for a Pap test?

Many things can cause wrong test results by washing away or hiding abnormal cells of the cervix. So, doctors suggest that for 2 days before the test you avoid:

• Douching
• Using tampons
• Using vaginal creams, suppositories, and medicines
• Using vaginal deodorant sprays or powders
• Having sex

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Should I get a Pap test when I have my period?

No. Doctors suggest you schedule a Pap test when you do not have your period. The best time to be tested is 10 to 20 days after the first day of your last period.

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How is a Pap test done?

Your doctor can do a Pap test during a pelvic exam. It is a simple and quick test. While you lie on an exam table, the doctor puts an instrument called a speculum into your vagina, opening it to see the cervix. She will then use a special stick or brush to take a few cells from inside and around the cervix. The cells are placed on a glass slide and sent to a lab for examination. While usually painless, a Pap test is uncomfortable for some women.

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When will I get the results of my Pap test?

Usually it takes 3 weeks to get Pap test results. Most of the time, test results are normal. If the test shows that something might be wrong, your doctor will contact you to schedule more tests. There are many reasons for abnormal Pap test results. It usually does not mean you have cancer.

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What do abnormal Pap test results mean?

It is scary to hear that your Pap test results are "abnormal." But abnormal Pap test results usually do notmean you have cancer. Most often there is a small problem with the cervix.

Some abnormal cells will turn into cancer. But most of the time, these unhealthy cells will go away on their own. By treating these unhealthy cells, almost all cases of cervical cancer can be prevented. If you have abnormal results, to talk with your doctor about what they mean.

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My Pap test was "abnormal," what happens now?

There are many reasons for "abnormal" Pap test results. If results of the Pap test are unclear or show a small change in the cells of the cervix, your doctor will probably repeat the Pap test.

If the test finds more serious changes in the cells of the cervix, the doctor will suggest more powerful tests. Results of these tests will help your doctor decide on the best treatment. These include:

• Colposcopy: The doctor uses a tool called a colposcope to see the cells of the vagina and cervix in detail.
• Endocervical curettage: The doctor takes a sample of cells from the endocervical canal with a small spoon-shaped tool called a curette.
• Biopsy: The doctor removes a small sample of cervical tissue. The sample is sent to a lab to be studied under a microscope.

The FDA recently approved the LUMA Cervical Imaging System. The doctor uses this device right after a colposcopy. This system can help doctors see areas on the cervix that are likely to contain precancerous cells. The doctor uses this device right after a colposcopy. This system shines a light on the cervix and looks at how different areas of the cervix respond to this light. It gives a score to tiny areas of the cervix. It then makes a color map that helps the doctor decide where to further test the tissue with a biopsy. The colors and patterns on the map help the doctor tell between healthy tissue and tissue that might be diseased.

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My Pap test result was a "false positive." What does this mean?

Pap tests are not always 100 percent correct. False positive and false negative results can happen. This can be upsetting and confusing. A false positive Pap test is when a woman is told she has abnormalcervical cells, but the cells are really normal. If your doctor says your Pap results were a false positive, there is no problem.

A false negative Pap test is when a woman is told her cells are normal, but in fact, there is a problem with the cervical cells that was missed. False negatives delay the discovery and treatment of unhealthy cells of the cervix. But, having regular Pap tests boosts your chances of finding any problems. If abnormal cells are missed at one time, they will probably be found on your next Pap test.

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I don't have health insurance, how can I get a free or low-cost Pap test?

Programs funded by the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) offer free or low-cost Pap tests to women in need. These and other programs are available throughout the United States. To find contact information for a program near you, visit the NBCCEDP web site athttp://www.cdc.gov/cancer/nbccedp/ or call 1-800-232-4636. Also, your state or local health department can direct you to places that offer free or low-cost Pap tests.