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FRIDAY, Nov. 20, 2009 (Health.com) — Young women should have their first Pap test no sooner than age 21, regardless of when they become sexually active, say new guidelines from the American College of Obstetricians and Gynecologists (ACOG). Earlier screening for cervical cancer may lead to unnecessary and possibly harmful treatments for an increasingly rare cancer, according to ACOG, the leading U.S. professional organization for obstetricians and gynecologists.

After age 21, women should have a Pap test every two years, instead of every year. At age 30, if a woman has no history of cervical cancer and has had three normal Pap tests in a row, she can be screened every three years, rather than every two to three years. (Women with certain risk factors, such as those who are HIV positive or who have a suppressed immune system, may need to be screened more often.)

However, annual pelvic exams—which are necessary for performing a Pap test—won’t necessarily be going away. ACOG says it may still be appropriate for women to visit their doctor annually for a pelvic exam, even if a Pap test isn’t performed. And sexually active adolescents shouldn’t wait until age 21 to see a gynecologist for the first time. (Such visits don’t necessarily have to include a pelvic exam.)

The guidelines were published this week in the journal Obstetrics & Gynecology.

ACOG had previously recommended that women receive their first Pap test three years after having sex for the first time, or no later than age 21, with annual checkups after that.

Why the change? Rates of cervical cancer, which is caused by the sexually transmitted human papillomavirus (HPV), have declined by 50% since the 1970s. Cervical cancer is now extremely rare, especially among women under the age of 30, the group most affected by the new guidelines. On average, just 14 cases occur nationwide in women between the ages of 15 and 19 each year, according to data from the Centers for Disease Control and Prevention. Among women ages 20 to 24, an average of 123 cases occur.

“The risk of invasive cancer is so exceedingly rare in this age group that to start screening at age 21 will still pick up the overwhelming majority of cases,” says Alan Waxman, MD, a professor of ob-gyn at the University of New Mexico School of Medicine, in Albuquerque, who led the preparation of the document spelling out the recommendations. “The incidence of cervical cancer in 15- to 19-year-olds has been reported at 1 to 2 per million girls. That’s a lot of unnecessary pelvic exams and unnecessary potential treatments that can be avoided.”

The cervical cancer rate will probably drop even further due to newer vaccines like Gardasil, which are now approved for HPV prevention in girls and women ages 9 to 26. However, ACOG says the vaccines won’t affect cervical cancer rates for 15 to 20 years, so they did not play a role in the new cervical cancer screening guidelines. Such vaccines don’t protect against all types of HPV that can cause cancer, so Pap tests are still necessary.

About half of all people are infected with HPV at some point in their lifetime, although the infection often goes away on its own. (Only in some cases does the virus damage cervical cells, causing abnormalities that can be picked up on a Pap test.)

Studies that ACOG consulted also show that screening older women every two to three years is nearly as effective as screening annually. And for women who’ve had healthy Pap tests for years, screening could probably be stopped around ages 65 to 70.

Next page: Guidelines not a major overhaul

Laura Doss

After being in a relationship for years (months, for some couples), climbing out of a dating rut can be difficult. That’s why we’re making it easy. Grab your significant other and get ready for a good—but different—time. Here are our 10 ways to shake up your date night. View the slideshow.

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Q: My husband wants phone sex when I travel for work. Help!

A: Sure, it sounds NC-17, but phone sex can be a great way for couples to bond when apart. You don’t need to turn into a phone-sex operator. Your man just wants to feel connected to you like he does when you’re actually in bed.

First, dim the lights and slip into something sexy. Start by telling your husband what you’re wearing, where you are, etc. Talk about the last time you had sex or what you would be doing to him if you were home. If the goal is an orgasm, describe what you’re doing to yourself, and ask him to do the same. Just relax and have fun!

Q: I used to have a healthy sex life with my husband, now I have zero, and I mean zero, interest. What’s wrong with me?

A: There are many factors—including stress and fatigue—that can affect sexual desire. It’s normal, for example, to not have the I-need-to-jump-your-bones feeling you did when you first met. When you’ve been with someone for a while, familiarity short-circuits desire.

To combat boredom, switch up the routine: Try passionate kisses instead of a peck when you leave in the morning or silk sheets on the bed. And more couple time can help keep you connected, which translates to hotter sex.

If you give it a try and nothing improves, check your meds: Some birth control pills and antidepressants can depress your libido. Discuss your concerns with your doc.

 
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It’s a common perception that only older women get breast cancer—old enough that they don’t really care if they ever have sex again. And boobs? Whatever, take ‘em… They already nursed their kids and the ta-tas are just getting saggy anyway. Right?

Wrong! I’m 26, and I have cancer in my breast. And no matter what age, women still want to be treated like the gorgeous creatures we are, even when hairless, probably throwing up and left ravaged by a mastectomy.

When I discovered my lump at 24, I was nearly scoffed out of a male breast cancer specialist’s office, who said I was statistically too young to have it. After some surly resistance on my part, I had my unidentified lump removed, but technically he was right: I didn’t have breast cancer. I had a vascular tumor called angiosarcoma: a very rare and nasty cancer that normally shows up in the heart or bone. And here I am now, two years later with different doctors, a new diagnosis and a 70 percent chance of dying within the next two years.

The months after my diagnosis were a painful blur. My boyfriend, Adam, doggedly called me beautiful and made sure that I was able to believe it. He was so caring and supportive when my oncologist said I would likely not have children because of the chemo. Instead of complaining or bolting for the door when my doctor said no sex because of the infection risk, Adam said, “I will wait for years. I don’t care about sex; I just want you.” I know that if our roles were reversed I would have done the same thing for him, but sometimes it’s still surprising to know that a person can love enough to put up with everything that you have to go through. I know he puts on a brave face for me every day—and I have seen him break down when he didn’t know I was looking. My bald head is covered in kisses, pats, rubs and fuzzy hats whenever he comes home or if I look sad or feel ugly. That is commitment. I wish everyone had a relationship like ours.

Next page: Chemo and more chemo

When my dad died last year, it was hard on me, of course, but also on my boyfriend. I was 24, he was 28, and the call came just a few weeks shy of our one-year anniversary. Suddenly he found himself sitting next to me in the front row of the church and meeting my extended family. We’d scheduled a vacation for the next month, so he was going to be stuck with a crying, grieving girlfriend for nine days.

He handled it with sensitivity and maturity, and the experience has brought us even closer. I’ve had boyfriends in the past who weren’t the consoling kind (“I’ve never heard of Shy-Drager Syndrome—how bad could that be? Are you sure your dad has that?”), so I considered myself lucky to have a boyfriend who could watch me break down in tears and hold me sympathetically without making inappropriate comments or breaking down himself.

In a cruel twist of fate, I got a taste of the other side when his mother was diagnosed with cancer less than a year after I lost my dad. Being the shoulder is a lot harder than he made it look. There’s not much you can say that will make things better, though you’re tempted to try.

Both of us experienced anticipatory grief (me knowing my dad would never dance at my wedding or hold his grandchildren, him wondering when and how his mother might go). But we expressed these sentiments differently. I needed to talk or cry at inopportune moments. He approached it from a more practical, scientific perspective. According to Roberta Temes, a psychotherapist who specializes in grief counseling and the author of Solace: Finding Your way Through Grief and Learning to Live Again, this gender difference is pretty typical.

“Women will talk to girlfriends more,” Temes says. “I once treated a couple who lost an adult son. The man played poker every Friday night. And he never told them why he missed two sessions. They never asked. The woman missed her mahjong games and when she came back, she said she needed to talk and everyone put away their tiles and cried with her. The community of women is accustomed to talking. The community of men is accustomed to getting on with it.”

Josh Bob, who lost his mother to cancer last year, says, “We’d known for months that it was an inevitability, so we were able to begin coping with it before she actually passed away.” Knowing it was going to happen didn’t make it easier, but Bob says his then-girlfriend helped him come to terms with the loss. It helped that she was studying to be a rabbi and happened to be taking a class about comforting mourners.

Next page: Remember these tips

Candlelight, red wine, freshly made pasta. Flirting at a small table in a corner infrequently visited by the waiter. Such are the makings of a great date.

But not if you can’t eat what they’re serving. What if you must start with a 10-minute interrogation: Can the scaloppini be prepared without a dusting of flour? Can I forgo the bed of pasta and just have the red pepper salmon? Does the chef use anything to thicken the risotto? Embarrassing. Your waiter takes a few trips to the kitchen to speak with the chef, and your date progresses in fits in starts. And—let’s be honest—you might seem a little high-maintenance (think Sally Albright, the picky heroine who ordered everything on the side in the romantic comedy When Harry Met Sally).

However, if you have celiac disease–a condition where the immune system reacts negatively to gluten, a protein found in wheat, barley, and rye–your questions aren’t a matter of preference. You must avoid the flour and pasta! Even if you aren’t a vegetarian or vegan or suffer from an intolerance or allergy, chances are at some point you’ll dine out with someone who is. In these situations, how do relationships fare?

Animal house
When 28-year-old New Yorker Erin clicked on 30-year-old David’s online dating profile, what she found was intriguing: he was a vegan. “I love food. I found it admirable that someone could choose to live such a restrictive lifestyle for the benefit of the planet,” she explains. Love blossomed as the two began to date, as did Erin’s initial interest in “converting.” “David introduced me to all kinds of food I’ve never tried,” she says. “Initially, it seemed like there were limitless possibilities.” Until, of course, they had hit all of the eight vegan restaurants in the city—twice. Then things felt a little limiting. “Eating out became kind of a pain, and eating in required quite a bit a prep work in the kitchen—unless we wanted to eat rice pasta every night,” she adds.

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Eventually, Erin began craving her old diet, and the love began to wane, as well. Turns out, Erin wasn’t cut out to live a vegan lifestyle—or date someone who did. “We weren’t a perfect match on a larger scale, but it did become a point of contention—that we were bound by this diet,” she says. Eventually Erin and David parted ways, and Erin found herself a traditional meat-and-potatoes man.

So does that mean we can only date within our own food circles? While Erin and her ex didn’t make it, plenty of couples do.

Next page: The gluten-free dater

Got a flat tire? Caught in a blizzard? Confronted by a scary dog? Most of us hope to never face the these scenarios, but we’ve got all the expert tips you need to be prepared for life’s curveballs. Check out the survival strategies below every modern woman must know.

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Okay maybe he’s not that into you, but you were pretty into him. So now what? Stay away from the ice cream and the trendy break-up novels and start taking action. A break-up is a significant change in your life that cannot be ignored.

MJ Ryan, author of AdaptAbility: How to Survive Change You Didn’t Ask For, shares her thoughts on breaking up:

Good grief:
“If you didn’t ask for it, you’re going to go through a grieving process. Ultimately you will get over it, but you’re not in charge of timing. [Just remember] there is a light at the end of the tunnel.”

There’s a time and a place:
“Don’t wallow in your negative and sad feelings. Give these feelings a time of day. If you find your mind going to these feelings, remind yourself that it’s not time for it yet, and distract yourself like crazy. Give your brain something else to think about.”

You’ve got mail:
Tell your friends you need support. “Send an emails saying ‘invite me to dinner,’ ‘invite me on vacation,’ or invite me over to your house.’ Your friends will be happy to do it because as friends we like to help, but oftentimes don’t know how.”

Control your actions:
“One of the things you are losing is a sense of control. Think of something you can do physically or mentally that is completely in your control like getting stronger and lowering cholesterol. These [types of goals] will help restore a sense of control over your life.”

 
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The first day at an new company isn’t that different from the fist day of school: You don’t want to fall flat on your face getting off the bus. Your reputation at the company depends on it. Here’s how to survive the first day and get off to a great start.

First Impressions Count:
It’s important to make a great impression on your first day at work. Peter Post, co-author of The Etiquette Advantage in Business says, “If you’re late, you’ll start off on the wrong foot. If you arrive five minutes early, people take notice. Reflect the attire of that company you’re joining. The two most important things are to be on time and dress appropriately.”

It’s All in a Name:
Have trouble remembering names? Peter Post suggests, “Do your homework. Find out who you’ll be working with from a hiring manager prior to your first day. Get a list of 3 or 4 names so you already have a name to put to a face. When you do get there, repeat their name a couple of times so you imprint that person’s name on your brain.”

Dress to Impress:
Don’t know what to wear? Fashion stylist Sarah Conroy says, “The most important thing to do is ask about the dress code before your first day.” If you don’t have the opportunity to check the dress code, Conroy suggests wearing “A nice pair of slacks with a top that doesn’t show too much skin.” She adds, “I would also bring a removable sweater or jacket, as well as carry an extra pair of shoes in my bag. You could wear a flat or a heel depending on how dressed up everyone is. It’s important to blend in at work.”

Fashion Emergency:
“To maintain your professional look throughout the day, keep a garment care kit filled with a safety pin, sewing kit, a stain stick and an extra pair of hose or tights in your desk so you’re prepared for a quick fix situation,” Conroy says.

Invited to a last minute company dinner?
“That is the exact reason why every woman should keep a dressier pair of shoes at her desk. It might be a smart idea to keep accessories around, as well as your staple pieces of makeup at your desk to refresh your look before heading out.”

 
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It’s not everyday you’re faced with life-saving decisions, but if you are do you know how to help a choking victim or someone having a cardiac arrest? Read on—it might just help you be a hero.

Choking Update
The Red Cross now suggests five sharp back slaps to the mid to upper back between the shoulder blades before you try the Heimlich Maneuver.

If the back blows don’t work, move on to five Heimlich attempts, then alternate five of each move until emergency help arrives.

Save a heart with fast action
When someone is having a sudden cardiac arrest, survival odds go down 10% for every minute you do nothing.

Call 911, start CPR, and grab the nearest defibrillator (a portable device that jumpstarts the heart with a shock and gets it pumping regularly; your office and gym should have one).

Don’t be afraid of the defib machine; it gives you instructions and it can’t do any harm.

 
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