Your health is a concern shared by you and your doctor. Your doctor takes care of your basic health needs and treats problems. This includes telling you about leading a healthy lifestyle and doing tests and exams to look for disease. It is up to you to follow a healthy lifestyle and be aware of any changes in your body that may signal a problem. Even if you are not having any problems, you should see your obstetrician–gynecologist, or ob-gyn, for routine checkups.

This article will explain:

• The role of your ob-gyn
• The kind of care you can expect to receive
• How you can work with your doctor for better health

An ob-gyn is a doctor who specializes in the care of women. He or she is trained in obstetrics — the care of pregnant women. This includes:

• Preconceptional period (before pregnancy)
• Pregnancy
• Labor and childbirth
• Postpartum period (after a baby is born)

Ob-gyns also are trained in gynecology. Gynecology covers a woman's general health care. This includes care of her:

• Reproductive organs
• Breasts
• Sexual function

It also includes treating hormone disorders and infections. Your ob-gyn also is trained in surgery to correct or treat pelvic organ or urinary tract problems.

Your ob-gyn offers preventive health care, too. This can help you to make choices that will prevent health problems. Preventive health care includes exams and routine tests that look for problems before you are sick. It also includes immunizations to prevent disease.

Your doctor can evaluate your health and provide care for a range of medical problems, not just those of the reproductive system. For many women, the ob-gyn is their primary care physician — the doctor they turn to first for health care.

Your Ob-Gyn's Qualifications

All ob-gyns receive complete medical training. Their training equips them to give general care to women, as well as care that relates to pregnancy and the reproductive organs. Ob-gyns have earned degrees from college and medical school. They also have completed a four-year course of special training — a residency — in obstetrics and gynecology.

After residency, a doctor may be board certified by the American Board of Obstetrics and Gynecology. To become board certified, the doctor must pass two tests. The first is a written test. This test shows that he or she has the knowledge and skills required to treat women. It covers both medical and surgical care.

He or she also must show experience in treating women's health conditions for two years in practice after residency. At this point, he or she takes a second test — an oral exam given by a panel of experts. This exam reviews the skills, knowledge and ability to treat many conditions. It includes a review of cases treated during the past year. Doctors certified after 1986 must be recertified in 10 years.

There are three subspecialty areas in obstetrics and gynecology:

• Gynecologic oncology (care of women with cancers of the reproductive system)

• Maternal–fetal medicine (care of women whose pregnancies are complicated by medical or obstetric problems)

• Reproductive endocrinology (care of women who have hormonal or infertility problems)

All certified ob-gyns can treat patients with these disorders. Some doctors have special training that qualifies them to take a test to be certified in these areas. Such doctors often teach other doctors.

If the letters FACOG are written after your ob-gyn's name, it means that he or she is a Fellow (full member) of the American College of Obstetricians and Gynecologists (ACOG). All ACOG Fellows are board certified. ACOG is a national group of more than 36,000 ob-gyns. It supports women's health care issues and offers a range of teaching programs to help doctors keep up with the latest advances in women's health care.

Your doctor may be a Junior Fellow in ACOG. Junior Fellows are in a training program or have just finished training. They are in practice preparing to pass the final oral exam.

Your ob-gyn may work as part of a health care team of other professionals. This is known as a collaborative practice. This health care team is led by the ob-gyn and may consist of:

• Residents — Provide care to patients at teaching hospitals after graduation from medical school.
  
• Certified nurse–midwives — Care for women during pregnancy and childbirth. They have an extra 12 to 18 months of schooling after graduating from an accredited nursing program and must pass a national certification exam.
  
• Nurses — Assist doctors in providing patient care and education. They have completed accredited nursing programs and passed tests.
  
• Nurse practitioners — Provide a wide range of services, which includes obtaining medical histories, doing physical exams, and diagnosing and treating common illnesses and diseases. They are licensed registered nurses who have advanced education. In some states, they must pass a national certification exam.
  
• Physician assistants — Handle various medical duties. They have completed at least a two-year educational program after college.
  
• Dieticians — Give advice and guidance on diet and nutrition.
  
• Social workers — Provide counseling and information on community services. They have studied in a special program and must be licensed.
  
• Childbirth educators — Teach parents-to-be about conception, pregnancy, birth and parenting.
  

Collaborative practice brings together health care professionals with different knowledge and skills. They work as a team, and each member has a role. In this type of practice, patients receive care from many types of professionals. Each person does what he or she does best. Services are provided in a cost-effective manner that may save you waiting time, too. The contributions of each member are key to the care of the patient.

What Kind of Care Does Your Ob-Gyn Provide?

The care provided by your ob-gyn can range from a basic gynecologic exam to complete health care of reproductive or other disorders. The type of care depends on your needs and options available.

Well-Woman Visit
The well-woman visit is a key part of preventive care. This consists of an evaluation of your general health and an exam of your breasts and pelvic (reproductive) organs. With this exam, your ob-gyn:

• Looks for health problems in their early stages
• Detects risks to your health
• Tells you how you can change your lifestyle to lower these risks
• You also may have certain tests and immunizations. It depends on your age.

You should have a well-woman exam on a routine basis if you are sexually active or age 18 or older. Most women should see their ob-gyn once a year. More frequent exams may be needed based on your health risk factors. If you have a health problem or notice any changes in your body, such as an unusual vaginal discharge or genital itching, you should contact your doctor right away.

Health History
During your exam, one of the first things your doctor does is obtain a history of your health. This will include information about:

• Your past illnesses
• Family health history
• Your menstrual periods
• Use of medications and birth control
• Whether you are or ever have been pregnant

The Pap Test During the Pap test, cells are taken from the cervix to look for changes that could be a sign of cervical cancer or changes that could lead to cervical cancer. The test detects possible signs of disease in women who do not have symptoms such as bleeding, pelvic pain or discharge. You should have your first Pap test by age 18 or when you become sexually active. Women are advised to have a Pap test once a year. Based on test results and the presence of any risk factors for cervical cancer, this test may need to be done more or less often. It's best to check with your doctor. The doctor performs the Pap test during your pelvic exam. To ensure accurate results, you should arrange to have the test when you're not having your period. Do not douche or use vaginal medication for two to three days beforehand. First, a speculum is inserted into the vagina so the cervix can be seen. Then a small brush or swab and applicator are used to remove cells from the cervix. You may have some spotting for a day or two after the test, especially if you're pregnant. Cells will be taken from inside the opening of the cervix and from the outer part of the cervix. They are sent to a lab to be tested. A trained technician or doctor looks for cells that do not appear normal. Results are based on how the cells look. The Pap test is the best way to detect conditions that may lead to cervical cancer. By treating these conditions, cancer often can be avoided or treated early.

If you have any poor health habits, such as smoking, a high-fat diet, or drug or alcohol abuse, you should discuss these with your doctor. These habits can increase the risk of disease and have a bad effect on your overall health. Also, smoking and substance use can harm the health of your baby if you are pregnant.

Your doctor can help you break poor habits and replace them with healthier ones. If you are sexually active or planning to be, your doctor also can talk to you about contraception and prevention of sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV).

Physical Exam
The general physical exam often begins with a check of your weight and blood pressure. Your doctor also may listen to your heartbeat and feel your abdomen and neck. The exam is based on your age and any risk factors you may have. The gynecologic exam is done to assess the health of your reproductive organs.

Your ob-gyn will first check your breasts for signs of lumps. You should do a breast self-exam regularly. If you are not sure how to do this exam, your doctor or nurse can teach you.

After examining your breasts, the doctor does an exam of your pelvic organs. You will be asked to lie on a table with your legs raised and your knees bent and spread apart. The doctor first examines the outside genitals (vulva). He or she then will insert a slender device called a speculum into the vagina to view the vagina and cervix and take a sample of cells for testing. After the speculum is removed, the doctor inserts one or two gloved fingers into the vagina and reaches up to the cervix. The uterus and ovaries can be felt from the inside with this hand while the other hand presses on the abdomen from the outside. This allows the size, position and shape of these organs to be checked.

During the exam, your doctor also may examine your rectum using a gloved finger. The exam can help your doctor detect any tumors or lumps or other problems that may be present.

Tests
The type of tests you receive and how often they are done depend on your age and whether you are at risk for any disease. One test that all women should have on a regular basis is the Pap test. This is done during the pelvic exam. The doctor uses a cotton swab or brush to take a sample of cells from the cervix. These are studied in a lab for signs that could signal cancer of the cervix (see box ).

Other tests also may be part of your well-woman exam:

• Cholesterol test is a blood test done to check levels of cholesterol, a substance that helps carry fat through the blood. Patients with a high cholesterol count are advised about diet and other preventive health measures.

• Mammography is an X-ray of the breasts to detect breast cancer.

• Fecal occult blood test is a test of a stool sample for hidden blood that may detect colon or rectal cancer.

• Sigmoidoscopy is the use of a slender device placed into the rectum and lower colon to look for cancer.

• Urinalysis is a test done on urine to look for changes that might be a sign of illness.

• Blood count is a test to detect anemia and infection.

If you are concerned about being exposed to STDs, including HIV, tell your doctor. He or she may suggest you have certain tests done.

Care of Reproductive and Other Conditions
Your ob-gyn can detect and treat a number of medical conditions that affect the reproductive system. An ob-gyn also may treat certain medical conditions that do not involve the breasts or reproductive organs. This is key for women who don't regularly see a doctor other than their ob-gyn.

In some cases, the ob-gyn will diagnose a medical problem and refer the patient to another doctor for treatment. In others, the ob-gyn can treat the problem and provide routine health care. The decision on how to treat a disorder depends on how severe it is, whether it is getting worse or is under control, and the comfort level of a woman and her doctor.

Finally...

You and your ob-gyn can work as a team to ensure your good health. If you take proper care of yourself, visit your doctor regularly, and report any symptoms that may signal a problem, you will increase your chances of staying healthy. It is always better to prevent illness — through a healthy lifestyle and preventive care — than to treat it.

Glossary

Collaborative Practice: A type of practice where care is given by a team of professionals.

Gynecology: The branch of medicine that involves care of women's health, including the reproductive system and breasts.

Obstetrician–Gynecologist: A doctor with special skills, training and education in women's health care.

Obstetrics: The branch of medicine that involves care of a woman during pregnancy, labor, childbirth and after the baby is born.

Pap Test: A test in which cells are taken from the cervix and examined in a lab for abnormalities that could signal cancer.

Sexually Transmitted Disease (STD): A disease that is spread by sexual contact, including chlamydia infection, gonorrhea, genital warts, herpes, syphilis and infection with human immunodeficiency virus (HIV, the cause of acquired immunodeficiency syndrome [AIDS]).

Vulva: The lips of the external female genital area.