Women’s Health

MANAGING THE UNIQUE ‘UPS & DOWNS’ OF WOMEN’S HEALTH

BY JULIE DUNLAP // PHOTOGRAPHY BY TRENTON BUSH

Knowing your body and following the latest protocols are vital to optimal health.

Creating and following a plan for gynecologic health as an adult can be as confusing and frustrating as learning to insert that fi rst tampon. Luckily northeast Kansas is home to some of the most cutting-edge prevention, screening and treatment available in the nation for cancers specifi c to the female body, and access to that care is often an easy phone call away. Read on for the latest protocols and share this with friends; it just might save a life.

BECOME THE EXPERT ON YOU

Throughout her 30 years of practicing obstetrics and gynecology, Dr. Sandra Stites, Chief Medical Offi cer at Vibrant Health in Kansas City, KS, has strongly encouraged patients to pay close attention to the way their bodies feel as they change over the years.

“Know your body,” says Stites, emphasizing that the fi rst vital step to optimal healthcare is for patients to feel confi dent and empowered to notice and communicate any changes to their healthcare providers.

Because the last formal health education most adults (who do not pursue careers in the healing arts) receive likely comes from a semester-long high school health class, decades later such anatomical terms might retreat to the deep recesses of the brain. While polite company often defers to terms like “The Girls” or “The Lady Parts” when referencing the upper and lower female anatomy, healthcare providers generally do not. Knowing and being comfortable using the correct terminology is the fi rst step in gynecologic health.

DOWNSTAIRS

“Vagina” and “uterus” may seem rather straightforward, but there is much more going on down there than that. Exploring the lower half of the female body from the outside-in, the fi rst stop is the vulva, i.e., the outer area typically contained in (most) bikini bottoms. The term “vulva” encompasses the labia majora (where hair can grow), labia minora (smaller, smoother, more central) and the clitoris (just north of the urethra).

The actual vagina is the approximately threeinch-long internal tunnel leading from just inside the labia minora into the pelvis. The end of the vagina connects to the cervix, which is the opening to the uterus. If the cervix could be compared to a thick, pliable opening to a drawstring bag, the vessel of the bag itself would be the fundus, or the upside-down, pear-sized part of the uterus.

The inside of the uterus is lined with endometrial tissue that replenishes and either sheds each cycle or supports a fertilized egg from implantation through pregnancy. It is the magical organ that can cause monthly cramping or grow a whole human being.

In this way, it is extremely diff erent from a regular drawstring bag.

Moving right or left from the top of the uterus are the fallopian tubes, one on each side, reaching four to fi ve inches in length to the ovaries, pecan-sized glands that store and release eggs and hormones from puberty through menopause.

Tiny but mighty, the ovaries typically take turns releasing eggs each month through the fallopian tubes in search of the right sperm for fertilization. (Spoiler alert: Most of the time, they do not.)

UPSTAIRS

Given that breasts are visible in a full-sized mirror and much easier to see than the lower region, there is generally less mystery about them. The tiny opening in each nipple leads to milk ducts and glands inside, surrounded by breast tissue that can vary greatly in density, with breast tissue and lymph nodes extending into the armpit.

But no matter the size or shape, they all deserve the same care and attention.

THE CARE AND KEEPING OF YOU

Maintaining a healthy second and third base happens in diff erent ways at diff erent ages, and the earlier women start paying attention to those areas, the better armed they are to recognize changes that may require medical intervention. Recommendations vary slightly between medical associations, but most agree that regular gynecologic exams should begin by the age of 21, depending on health history and sexual activity.

Pap smears (or Pap tests, named after the scientist, George Papanicolau, who developed the procedure nearly 100 years ago) often get a bad rap, but what they may lack in comfort, they make up for in their ability to detect cervical cancer.

The patient lies face up on an exam table with her feet in stirrups and her bottom exposed at the very edge of the exam table. The healthcare provider moves like a ninja, slipping a speculum (think: a small pair of salad tongs that gently open) into the vaginal canal and, guided by good lighting and a clear view, collects cell samples from the outside and inside of the cervix using a teeny, tiny brush.

“The Pap test identifi es cervical cancer at an early stage; the cells change long before they turn into cancer,” Stites says. “You can start to see those cells become abnormal before they actually turn into cancer so you can treat it.”

Cervical cancer is currently the only gynecologic cancer with an FDA-approved vaccine. Gardasil, a series of injections typically recommended for patients ages 9 to 45, guards the body against the human papillomavirus (HPV), which can cause cervical cancer.

“With Gardasil, we have seen the number of cervical cancers absolutely plummet,” Stites says.

Typically a PAP smear is followed by a manual pelvic exam, where the healthcare provider assesses the cervix, inner vagina, uterus and ovaries for size, pain and other abnormalities by palpating around them from both inside the vagina and surface of the pelvic area. The manual pelvic exam is helpful in detecting

Dr. Sandra Stites PHOTO COURTESY OF VIBRANT HEALTH vibranthealthkc.org

Is it pleasant? No. Does it take very long? Also no. Is it important? Absolutely.

symptoms which may not otherwise present in daily living, especially for patients who are tuned in to changes in their bodies.

The healthcare provider will also likely perform a clinical breast exam, using both hands to palpate around the breast from the nipple into the armpit.

This is one exam people can -- and should -- perform on themselves at home each month as well. The National Breast Cancer Foundation states that 40% of diagnosed breast cancers are detected by patients who feel a lump.

Stites emphasizes that patients should never be hesitant to contact their practitioners after fi nding an unusual lump, saying, “If you’re doing your examinations on a regular basis, it’s enough to say ‘it’s diff erent than the way it used to be’ for us to pursue further testing.”

The earlier patients begin performing a Self Breast Exam (SBE), the better.

“I start them as soon as I see them, at age 18,” Stites says. “I recommend that because I like to build muscle memory. I want them to hear me say that year after year so they share it with their roommates in college, and it just becomes a habit.”

While statistics may show breast cancer to be most common after 40, her patients who begin these exams early in adulthood not only sharpen

One in eight women will be diagnosed with breast cancer in her lifetime.

their skills and know their bodies better, but they have a better chance at catching the lumps that may otherwise not be found until it is too late.

“My youngest patient with breast cancer was 26, and she found it herself,” says Stites, noting that under all standard recommendations, the lump would not have been found in time by routine mammogram. “If you’re healthy, you’re only going to see me in the offi ce once per year. And that only gives me one opportunity in a year to check your breasts. If you’re consistent with when you do it according to your cycles, you’re more likely to get a similar feel each month.”

GET THAT MAMMOGRAM

While the SBE can provide an excellent external assessment each month, an annual mammogram creates a detailed map capable of detecting abnormalities at their earliest stages of development. Guidelines vary slightly depending on a person’s health and family history, but most healthcare organizations agree that a baseline mammogram for otherwise healthy women with no known increased risk for breast cancer be performed at or after 40 years of age.

Like the Pap smear, this is not an event most patients look forward to. Also like the Pap smear, this process is quick and impactful, and fi nding the right provider can make all the diff erence in the world.

Mammography Supervisor at LMH Health in Lawrence, KS, Julie Anno, recommends fi nding a mammography center that is accredited in mammography by the American College of Radiology, which is common for most centers in the region. Centers may also have additional accreditations.

“LMH also has accreditation in their mammography biopsies as well as breast ultrasound and breast ultrasound biopsies,” Anno says.

The breast center recently added another diagnostic tool, the Tyrer-Cuzick Score.

“For all of our screening mammogram patients, we take a family and personal history of cancers and gynecologic history and put it into a tracking system that gives them their lifetime risk (called the Tyrer-Cuzick Score) of developing breast cancer,” Anno says. “When the radiologist reads their images, they take that score and weigh it against how dense their breast tissue is.”

ACA-qualifying insurance plans are required to cover 100% of preventative care screenings, including annual wellness exams and

Julie Anno MBA-HCA, RT (R)(M) Mammography Supervisor

recommended gynecologic exams and mammograms. Uninsured and underinsured patients can access this same care for limited to zero cost by contacting their local health departments for referrals to clinics that provide these screenings on a sliding scale.

CANCER CARE IN NE KANSAS

Approximately one in eight women will be diagnosed with breast cancer in her lifetime; 1 in 35 will be diagnosed with endometrial cancer; 1 in 78 with ovarian cancer; 1 in 142 with cervical cancer. Each of these cancers initiates in its own organ or gland. Though they can metastasize to diff erent organs, they are each composed of their own type of cancer cells and maintain their own genetic code unique to their area of origin, and each one has its own unique treatment plan.

While no one ever wants to receive this diagnosis, oncology patients in Kansas can take comfort in knowing they have access to top-notch treatment right here at home. In July of 2022, the University of Kansas Cancer Center in Kansas City achieved designation as a National Cancer Institute Comprehensive Care Center, one of only 53 in the nation.

Seventeen hospitals, health systems and medical centers in Kansas and Missouri are now members of the Masonic Cancer Alliance (formerly the Midwest Cancer Alliance), which works with the KU Cancer Center to enhance the ability for its practitioners to deliver advanced cancer care to patients across Kansas and Western Missouri. This regional network allows patients more local access to the highest levels of cutting-edge research, education and treatment available through the KU Cancer Center.

For more information on the MCA, visit: masoniccanceralliance.org

PARTY WITH A PURPOSE

The Breast Cancer Health Equity Task Force and Community Advisory Board for Project BRA, facilitated by the MCA, can bring a mobile mammography unit to your church, gathering or other community group. The Friendto-Friend events are evidencebased programs designed to make mammograms accessible to all communities in the Greater Kansas City Area.

CONTACT: kansascancerprojects.com

MAMMOGRAPHY 101

Whether you are prepping for your fi rst mammogram or your 20th, here are some tips from Julie Anno, Mammography Supervisor at LMH Health: DO make your appointment today (and encourage a friend to join you). DON’T worry … technology has come a long way in the last 20 years and the process is much more comfortable and accurate. DO arrive 15 minutes early for paperwork, and have a doctor to list who can receive the report. DON’T wear dresses, if possible, as you will be undressed from the top on up. DO take a shower. You will be asked to wipe off any deodorant. DON’T DELAY! Call your local mammography center or health department today. n