FAQ


When do I need a referral to see Dr Leon?

The Medical Services Plan (MSP) of BC requires a referral from your family care provider if you were not seen in 6 months. This could be done by letter, fax or phone. Once the referral is received, then an appointment can be scheduled for your visit. If after the initial consultation, a follow up is required to assess your response to treatments or the passage of time, then you don’t need a new referral within 6 months. Cancer follow-ups can be seen without a re-referral.

Can I see Dr Leon without a referral?

A private consultation can be arranged if patients do not have MSP coverage, or wish to see Dr Leon privately. Some parts of gynecology and preventative medicine, such us anti-aging and the use of bioidentical hormone therapy are not covered by MSP.

What type of exams should I expect when I see Dr Leon?

It depends on the clinical situation; for example, it will be different if we are concerned about cancer, a hormonal imbalance or just a check-up. The basic or regular gynecological exam includes the following:

Optional tests that may be required at the time of the exam include:

Above and beyond the gynecological exam, optional exams include:

Can I come when I am having my period?

You are welcome to come and discuss your concerns, your response to treatment, to change or renew prescriptions, but tests such as Pap smear are not conducted during this time. If you have spotting or light bleeding, procedures such as an IUD insertion and ultrasounds can still be carried out.

Can I bring a family member or friend to the appointment?

Yes, you are welcome to bring a companion, such as husband, boyfriend, mother or just a friend with you. That person could be present during the discussions, and during the examination as well. If you want my assistant to be present during any exam, you just need to ask.

Does Dr Leon see pregnant women?

I can see pregnant women in very selected cases, and not after 20 weeks in pregnancy.

I have stopped delivering babies now. I did not feel strong enough to provide a 24-hour service, as our body becomes less forgiving with the passage of time. As much as I enjoy delivering babies, by body said STOP.

I can carry out EARLY PREGNANCY ASSESSMENT using ultrasound and blood work in selected cases. This could be important in women who had a previous tubal pregnancy or several miscarriages, or in women who are spotting or bleeding in early pregnancy. But somewhere between 12 and 20 weeks in the pregnancy, and if you need to see an obstetrician continuously, either your G.P. or I will arrange the transfer of care.

Can I see Dr Leon for my pap test?

In women who are due, it can be performed as part of the gynecological examination. Others who had a previous abnormal pap or operations in the cervix may also need a pap in my office.

What does it mean when my pap test comes back abnormal?

A mildly abnormal Pap test result means that some cells sampled from your cervix do not look normal. Abnormal Pap test results are very common, especially in young women, and don't mean you have cancer. Most the abnormalities resolve on their own. That is why most women just need a repeat Pap test in 6 months to monitor the abnormality, until it disappears.

It's rare for women with an abnormal Pap test result to have cervical cancer. However, when markedly abnormal cells are found, or when the mild abnormality persists for a number of years, you need to have a test called colposcopy, to clearly define where the abnormal cells are coming from, and to treat if necessary.

If I had obtained your Pap test, I or my office will call you in 6-8 weeks to let you know the result, and when the next one is recommended.

How can I interpret the results of biopsies?

Endometrial biopsy or curettage

In women over 40 with abnormal bleeding (sometimes in younger women too), women who bleed 1 year after menopause, or if the ultrasound showed excessive thickening of the lining, a sample of tissue is obtained. The tissue goes to the pathology lab here in Kelowna, and we get the results 2-3 weeks later. The office will let you know the result, unless you have an appointment to discuss it, plus make treatment plans. Results can be divided into 4 groups:

Cervical polyps

The tissue goes to the pathology lab here in Kelowna, and we get the results 2-3 weeks later. The office will let you know the result, but cervical polyps are almost invariable benign, and no further follow up is required.

Vulvar biopsies

The tissue goes to the pathology lab here in Kelowna, and we get the results 2-3 weeks later. Depending on the reason for the biopsy (suspicious of skin disease, or cancer, or just to check a cyst that was removed), we’ll either let you the result by phone, or we may need to discuss it in person.

How often should I have Pap tests, Swab for STD’s and mammograms?

Pap tests:

The BCCA recommends that women should start having Pap tests at age 21 or 3 years after first sexual contact. Pap tests should be performed every year for the first 3 years; then continue every 2 years if your results are normal.

Pap tests may be stopped after age 69 if you have had normal Pap test results in the past and no history of significant abnormalities. It can also be discontinued in women who had a hysterectomy for a non-cancerous growth such as fibroids.

Swabs

Swabs are taken from the vagina or the cervix to check for yeast and other bacterial infections, such as Bacterial Vaginosis (BV), trichomonas, Chlamydia and Gonorrhea. Chlamydia is the most common bacterial STD (sexually transmitted disease), or STI (sexually transmitted infection). It can be present in 4-5% of women younger than 25. A chlamydia infection does not always cause symptoms. The Public Health Agency of Canada (PHAC) recommends checking for chlamydia for:

In women, the swab for Chlamydia and Gonorrhea can be collected from the vagina (this is the most accurate), either as a self-test or by myself, from the cervix (by myself), rarely from the urethra or rectum, and from the urine (self-test, but it is not as accurate in women as the vaginal or cervical swab). The results usually take 3-4 days, and we’ll let you know the results.

Mammograms

According to the BCCA, about 1 in 9 women will develop breast cancer in her lifetime. 1 in 28 women is expected to die from the disease. Regular screening mammograms can find breast cancer early, usually before it has spread. Research has shown a 25% reduction in deaths amongst women who screen regularly.

Make it part of your regular health routine, after 50 years and every 2 years going forward. Earlier and more frequent mammograms can be done in high risk cases.. In Kelowna, the mammograms can be booked by phoning 250-861-7560. Location is the Kelowna Medical Imaging, 108-3330 Richter Street, Kelowna, BC.

The BCCA has a decision tool aid, to help you determine when you need a screening mammogram. http://www.screeningbc.ca/Breast/default.htm. You usually get your result in the mail.

Colonoscopies, FITT test

The BCCA recommends that women and men ages 50-74 should get screened regularly for colon cancer. Colon cancer screening saves lives in two important ways:

There are 2 different tests available – the fecal immunochemical test (FIT) and colonoscopy. FIT is recommended every 2 years for people who do not have a personal history of adenomas or a significant family history of colon cancer. Colonoscopy is recommended every 5 years for people with at least 1 of the following:

Screening is only recommended for people who are not experiencing symptoms. You may need a referral for diagnostic testing if you are experiencing blood in your stool, abdominal pain with change in bowel habits and/or unexplained weight loss.

If you have a personal history of colon cancer, ulcerative colitis or Crohn’s disease, you should continue to obtain care through your specialist or doctor as you have individual needs that cannot be met with a population approach to screening.

What do I do if there is yeast or bacteria in the swab result?

Yeast

Yeast (Candida) is considered part of the normal vaginal flora, but an overgrowth of the organism and penetration of superficial epithelial cells can result in vaginal infection. Although some women do not feel anything, the most common symptoms include vulvar burning, soreness, and irritation and sometimes pain during urination and during intercourse.

The vulva and vagina appear red, and vulvar excoriation and fissures may be present. Sometimes there is little or no discharge; when present, it is classically white, thick, adherent, and clumpy (curd-like or cottage cheese-like) with no or minimal odor.

The diagnosis is best made by finding the candida on a microscopy slide or a vaginal swab.

The majority of infections are due to the strain called candida albicans, which responds well to the regular over the counter yeast medications, but the second most common strain is called candida glabrata, which respond better to Boric Acid.

Treatment is indicated to relieve symptoms. Asymptomatic women do not usually require treatment.

Oral and topical creams drugs achieve comparable clinical cure rates, which are in excess of 80 percent. The best treatment is a single dose of oral fluconazole (150 mg) for treatment of uncomplicated infections. More intense and repetitive infections require longer treatments.

If candida Glabrata is present or suspected, intravaginal boric acid (600 mg capsule once daily at night for two weeks) works better. This medication can be toxic in children if ingested by mouth, so it should be stored securely.

For women with recurrent infections, which most authorities agree is more than 4 episodes per year, long term suppressive maintenance therapy is recommended. The initial treatment with fluconazole 150 mg is repeated every 72 hours for three doses, then the maintenance dose is fluconazole 150 mg once per week for six months.

There are a number of factors that predispose to symptomatic including poorly controlled diabetes, the use of broad spectrum antibiotics, increased estrogen levels, such as oral contraceptive use (especially when estrogen dose is high), pregnancy, and estrogen therapy in menopausal women, in immunosuppressed patients, such as those taking glucocorticoids or other immunosuppressive drugs, or with human immunodeficiency virus (HIV) infection, use of vaginal sponges and diaphragms.

Yeast infections are not traditionally considered a sexually transmitted disease (STD) since it occurs in celibate women and since Candida species are considered part of the normal vaginal flora. However, this does not mean that sexual transmission of candida does not occur or that vaginal infections is not associated with sexual activity. For example, an increased frequency of vulvovaginal candidiasis has been reported at the time most women begin regular sexual activity. In addition, partners of infected women are four times more likely to be colonized than partners of uninfected women, and colonization is often the same strain in both partners.

Although sexual transmission of Candida species can occur, most experts do not recommend treatment of sexual partners since sexual activity is not a significant cause of infection or reinfection. However, in woman with recurrent vaginal infections, this issue remains controversial. The value of probiotics, either oral or vaginal tablets, also remains unproven.

Bacterial Vaginosis

Bacterial vaginosis (BV) is the most common cause of vaginal discharge in women. BV itself is not harmful, although it has been associated with some health problems, such as a higher risk of premature delivery, infections of the surgical site after gynecological surgery, increased risk of becoming infected with genital herpes, gonorrhea, chlamydia and PID, and an increased risk of becoming infected with and spreading HIV.

The cause is an imbalance between the healthy bacteria, called lactobacilli or acidophilus, and other type called anaerobic bacteria, which overgrows. The reason for these changes is not known but risk factors for BV include multiple or new sexual partners, douching, and cigarette smoking.

BV is somehow related to sexual intercourse, although most recurrences are not sexually related. The American college of Obstetrician and Gynecologists called it a SAD (Sexually Associated Infection), as it is less common in women who do not have sexual relations, or when condoms are used.

A large number, approximately 50 to 75 percent of women with BV have no symptoms. Those with symptoms often notice an unpleasant, "fishy smelling" vaginal discharge that is more manifest after sexual intercourse. Vaginal discharge that is off-white and thin may also be present. Some patients have itching. Pain during urination or sex, redness, and swelling are not typical.

The diagnosis of BV is based upon a physical examination and laboratory testing. The physical examination usually includes a pelvic examination, and obtaining vaginal swabs.

Treatment of BV is generally recommended. There are two prescription medications used for the treatment of BV: metronidazole and clindamycin. Both medications can be taken in pill form by mouth, or with a gel or cream that is inserted inside the vagina. Oral medication may be more convenient, but causes more side effects.

Metronidazole vaginal gel is one of the most effective treatments; it is applied inside the vagina at bedtime for five days. Metronidazole can also be taken in pill form, 500 mg twice daily for seven days. The choice of pill versus vaginal gel depends upon the woman's preference. In general, there are fewer side effects with the vaginal treatment.

Side effects of oral metronidazole include a metallic taste, nausea, and vomiting. You should not drink alcohol while taking metronidazole pills due to the risk of a serious interaction, which can cause flushing, nausea, thirst, palpitations, chest pain, vertigo, and low blood pressure. The vaginal gel does not cause these side effects.

Clindamycin is a cream that is inserted into the vagina at bedtime for seven days. Clindamycin cream should not be used with latex condoms due to the risk of condom breakage.

Treating the sexual partner does not improve the woman's symptoms or decrease the risk of the infection coming back, hence treatment of male sexual partners is not recommended. However, metronidazole pills can be used in selected cases.

Unfortunately, 30 percent of women who initially improve after treatment have a relapse or recurrence of BV symptoms within three months, and more than 50 percent have a recurrence of symptoms within 12 months.

Relapse can be treated with a prolonged course of oral or vaginal metronidazole or clindamycin for seven days, followed by the used of Boric Acid 600 mg vaginal suppositories for 21 days, and then vaginal metronidazole gel twice weekly for four to six months.

Probiotic therapy appears to be of no value in preventing recurrence of BV.

How can you help?

Do not douche. Douching is the use of a solution to rinse the inside of the vagina. Some women douche to feel "clean", although there is no proven benefit of douching. The vagina is normally able to maintain a healthy balance of bacteria; douching can upset this balance and potentially flush harmful bacteria into the upper genital tracts (uterus, fallopian tubes).

Recurrent Bacterial Vaginosis

To recap, the cause of a BV is an imbalance between the healthy bacteria, called lactobacilli or acidophilus, and other type called anaerobic bacteria, which overgrows in the vagina. Comparable to weeds overgrowing and destroying a healthy lawn.

The reason for this changes is not known but risk factors for BV include multiple or new sexual partners, douching, and cigarette smoking. BV is somehow related to sexual intercourse, although most recurrences are not sexually related. The American college of Obstetrician and Gynecologists called it a SAD (Sexually Associated Infection), as it is less common in women who do not have sexual relations, or when condoms are used.

Unfortunately, 30 percent of women who initially improve after treatment have a relapse or recurrence of BV symptoms within three months, and more than 50 percent have a recurrence of symptoms within 12 months.

Presently, the best way to treat and prevent relapse is the following:

Repeat oral or vaginal metronidazole or clindamycin for seven days, then:

A small number of women develop a yeast infection with this regime.

When the relapse is infrequent, say 1-2 a year, you can just treat it when it happens. I can provide you with the treatment, but it is always ideal to get tested to confirm the diagnosis.

Probiotic therapy appears to be of no value in preventing recurrence of BV.

How can you help?

Trichomoniasis, Chlamydia, Gonorrhea

These 3 infections are considered true Sexually Transmitted Infections (STD’s). If the swabs return positive, I will need to see you in the office. Free treatment can be provided at your visit, which we obtain from the Public Health Agency of Canada. Treatment for the sexual partner can be provided free as well. There are many topics to discuss: how you got it, how to get rid of it, how to check that it is gone, what are the possible dangers, how to prevent a recurrence, what other STD’s should you be tested for, and what to do with the partner. Once we let you know the result is positive, we will let you know, and set up an appointment urgently so you don’t need to sit and worry.