Reproductive health services
Infection with HPV. Cervical cancer
I heard it is important to get tested for cervical cancer. What do I need to do?
Infection with HPV is responsible for voer 90% of cervical cancer cases. It is important to remember that you can get infected with HPV even if you use a condom. Vaccination and pap tests are essential in keeping yourself healthy.
In Romania, HPV vaccination is free through general practitioners for any girls between 11 and 18 years. Children of uninsured mothers, on the basis of a request submitted to the general practitioner's office.
Through the Support for refugee women program, boys between 11 and 18 years can access the HPV vaccine program. It is useful for them to get vaccinated for two reasons: they are protected from penile, anal and oropharyngeal cancer, caused by infection with HPV in men, and the odds of them infecting partners drop significantly.
Vaccination does not exclude pap smear tests!
Pap tests look to detect modifications in the cells of the cervix which would suggest cancer or other cellular anomalies of the cervix.
Free tests and analyzes
In Romania, pap tests are performed for free on the basis of general practitioner referrals to an obstetrics and gynecology service, once every three years. Some sections of ob-gyn allow for the performance of tests just on the basis of an identity document.
DNA HPV tests, which confirm HPV infection and the type of the strain (high risk or low risk), are not free except for a few special programs.
Periodically, there are Babeș Papanicolau screening programs for DNA HPV tests carried out through medical caravans in disadvantaged areas. At the moment it is unclear if Ukranian citizens have access to such programs.
Ideally, every sexually active woman should do:
the pap test once every 3 years between the ages of 21 and 29
the pap test and DNA HPV tests once every 5 years between the ages of 30 and 65
Patients with tuberculosis, HPV infection, history of cervical cancer, immunosuppressive medication must get tested annually.
Any modified result requires changes to the testing and eventual treatment program.
The Support for refugee women program was thought out to help Ukranian women and to cover some services, treatments and reproductive health products. It can help you get in contact with one of the doctors who can test you, council you, and can cover, if needed, the cost of tests and treatment.
Breast cancer
It is important for every woman to know her breasts and to visit a doctor if they notice any of the following symptoms:
A lump in their breast
Changes in the breast's size or shape
The appearence of little dents on the breast or the thickening of the breast tissue
Nipple retraction
An eruption on the nipple
Discharge eliminated through the nipple, more than a year after weaning
Swelling of the armpits or a lump in the area
Pain or discomfort at breast level, which persists
Skin redness
Skin thickening
In Romania, women who are ensure get one mammogram settled (compensated) once every two years, with a referral from their general practitioner to the obstetrician. These can be prescribed for unsymptomatic women between the ages of 50-69 who don't have a confirmed case of breast cancer and don't have history suggestive of breast cancer pathology.
A woman can have a medium to high risk of breast cancer
The woman with medium risk of breast cancer:
Has no personal history of breast cancer
Has no family history of breast cancer
Has no genetic mutations with high oncological risk (ex. BRCA)
Has not been administered radiation therapy to the torso before the age of 30
Recommended screenings for women with medium risk of breast cancer:
40-44 year olds have the option of a yearly mammography
45-54 year olds are recommended yearly mammographies
55 year olds are recommended mammographies every 2 years (life expectancy of minimum 10 years)
ideally tomosynthesis mammography (3D)
The woman with high risk of breast cancer:
Has a lifelong risk of breast cancer of 20-25% based on risk scores
Has a genetic test or has first degree relatives with BRCA mutations determined through a genetic test
Was administered radiation therapy to the torso between the ages of 10 and 30
Suffers or has first degree relatives who suffers from certain syndromes (Cowden, Bannayan-Riley-Ruvalcaba, Li-Fraumeni)
Recommended screenings for women with high risk of breast cancer:
From the age of 30: an annual mammography and MRI is recommended
For women with high risk of breast cancer because of:
a personal history of breast cancer
a very dence and heterogenous structure of the breast tissue, only one yearly mammography is recommended starting at the age of 30
If you know you have a high risk of breast cancer, it is important to follow the monitoring program descirbed above. breast cancer is a type of cancer with very high chances of recovery if detected on time!
Sexually transmitted infections
I have a vaginal discharge that smells weird. What can I do?
Sexually transmited infections (STIs) are plenty, which is why it is important that if you don't have a stable partner, you use a condom in any vaginal, anal or oral sexual contact.
If you have symptoms that are bothering you in the vaginal or perianal region (pain or stinging when peeing, pain or stinging during sexual acts, itching in the vaginal or perianal area, vaginal leackage or discharge with an abnormal smell, colour or aspect, irritations, wounds, sores or blisters in the vaginal area, on the buttocks, interior of the thighs, vaginal bleeding outside of menstruation, pain in the lower abdomen) it is important that you go to a doctor.
Gratuities
In Romania, insured persons can get a referral from their general practitioner to a doctor specialised in infectious disease or an ob-gyn. These can take samples of the vaginal discharge and, based on their results, they can prescribe you a treatment. It is important to follow this treatment as indicated, even if you no longer have symptoms. In the vast majority of cases, the doctor will prescribe a treatment for your partner as well. Some of this medication is compensated, some is not.
It is essential to let the partner you've recently had sexual contact with know, and to take measures to not infect other people if applicable.
Some STIs can severely impact a fetus. This is why, during your first gynecology consultation, the doctor will take discharge samples to detect them. It is important to go to the doctor if you have symptoms of vaginal infection during pregnancy!
There are many STIs that have no symptoms but can have serious consequences for your health (HPV infection, chlamydia, etc). Because of this, in the annual gynecological examination, a vaginal discharge examination can be done if your doctor considers you have a risk factor.
For consultations outside of the emergency medical care system, Ukranians can present themselves with an identity document and a travel document to any medical service rpovider in contract with CNAS (hospital, polyclinics in the state system, some clinics or doctors from the private sector). They have access to the basic healthcare coverage packet, which is what all Romanian citizens who pay their CNAS contribution can use.
If you have difficulties in accessing a medical consultation for infectious disease or obstetrics and gynecology, the Support for refugee women program can help put you in contact with one of the doctors who can test and counsel you and, if needed, can cover the cost of tests and treatments.