As cervical cancer screening recommendations have changed in the last few years, women were thrilled to find out they no longer needed an annual Pap smear. However, even if women only need that test once every 3 to 5 years, they should still visit their gynecologist annually.
Postmenopausal women (either by surgery or naturally) definitely need to come in for an annual exam. We recommend our patients do this at the end of the year when their deductible has typically already been met. Most insurance covers the annual check-up even if the patient hasn’t reached their deductible yet. For insurance purposes, annual exams are just check-ups, and any kind of diagnosis will need to happen at a later time.
Annual exams are extremely important but most ladies were taught to think they need a pap smear once a year. However, a pap smear is not the most essential thing. We are more focused on getting our patients to come in for their annual checkup, not an annual pap smear.
It’s important for all kinds of ladies, even if they aren’t on hormones, to come in once a year for their annual exam to monitor things like mental health, thyroid changes, and hormone changes.
The annual exam is performed by a medical provider with specialized training in gynecology. Annual gynecological exams are among the most important ways for women to receive preventive health screening and education that is specific to women.
A gynecologist is trained to care for women from adolescence through older age and understands a woman’s changing health care needs. They can address;
● bone health
● birth control
● breast changes
● sexual function
● urinary leakage
● vaginal infections
● menstrual problems
● preconception counseling
● sexually transmitted infection (STI) screening and prevention
Many of the conditions that affect women’s health, including the human papillomavirus (HPV), cervical cancer, and breast cancer, can exist without any signs or symptoms. Regular screenings can detect these conditions at earlier stages when they can be most effectively treated.
Additionally, providers counsel on ways to stay healthy including diet, exercise, smoking cessation, mental health, and vaccinations.
What to expect
The exam starts with the provider asking the patient about their medical history and then they will take the patient’s vitals. The provider will ask the patient about their periods, pregnancy history, sexual activity, contraception needs, medical history, and any current symptoms they are having.
The provider will listen to the patient’s heart and lungs, feel the thyroid gland in their throat, and feel their abdomen. The patient will also have a breast and pelvic exam. The pelvic exam consists of three parts: an external examination of the vulva, an internal examination with a speculum of the vagina and cervix, and an examination of the uterus and ovaries with a gloved hand.
We encourage patients to tell their provider if they find the pelvic exam uncomfortable or stress-inducing. Patients who experience this type of anxiety have reported that relaxation strategies, repositioning, and using a smaller size speculum can help improve their experience.
The gynecologist could also choose to perform a Pap Smear where they gently remove cells from the cervix during the speculum exam and send them to the laboratory for testing.
Finally, the provider will discuss ways the patient can improve their health including lifestyle changes, screening tests, or vaccinations based on their risk factors.
When to start GYN exams
The American College of Obstetricians and Gynecologists (ACOG) recommends that the first visit to a GYN provider take place between the ages of 13 to 15. This visit will focus on education and typically does not involve a pelvic exam.
Topics will include:
● normal development of sex organs
● preventing sexually transmitted infections (STIs)
● services related to birth control, STI testing, and HPV vaccination
● positive habits like balanced nutrition, maintaining a healthy weight and avoiding cigarette smoking
ACOG recommends that pelvic exams, including a Pap smear, start when a woman becomes sexually active or at the age 21, regardless if they’ve been sexually active or not.
There is not a set age for discontinuing these annual exams, although Pap smears may be reduced from annually to biannually for low-risk women ages 66 and up. A woman’s decision to stop having annual exams should be made after a discussion with her provider. There are certain things to consider, including if her uterus and ovaries have been removed or if they have a history of gynecological conditions that require continued monitoring.
Ideally, when a Pap smear is to be performed, we encourage patients to try to schedule their annual exam when they are not having their period. Additionally, it is helpful to avoid vaginal activities like douching, intercourse, or use of vaginal creams/medications for 48 hours prior to the exam.
Patients should bring a current list of medications and allergies, names of other providers who care for them, and any medical issues they have, including their history of surgeries and hospitalizations.
If a patient is experiencing abnormal bleeding or pelvic pain, a log of when these symptoms occur may be helpful for their provider.
Questions Patients Should Ask Their Provider
Any health-related question is fair game. There are some things a patient should definitely bring to the attention of their provider. Including:
● missed periods
● vulvar changes
● painful intercourse
● pelvic pain or bloating
● menopausal symptoms
● unusual vaginal discharge
● problems moving bowels or passing urine
● any breast concerns, such as pain, lumps, puckering, or nipple discharge
● abnormal bleeding, including heavy periods, bleeding in between periods, or bleeding after sex
Regular Health Screenings
Health screenings are used to identify diseases with little to no symptoms in otherwise healthy patients. The recommendations for the kinds of tests used and the frequency of tests vary depending on the patient’s age, risk factors, and family history.
In general, the following screenings are recommended:
● Chlamydia and gonorrhea. If left untreated, these STIs can lead to serious complications like pelvic inflammatory disease, infertility, and chronic pain. Annual testing is recommended for sexually active women under the age of 25. Women ages 25 and older may also benefit from testing if they have multiple partners, a new partner, exposure concerns, or have recently been diagnosed with another STI.
● HIV testing. This test should be done at least once during a patient’s lifetime. However, a patient’s provider should check for risk factors annually that could warrant repeat testing. Likewise, screening for other STIs like syphilis, trichomonas, herpes simplex virus, and hepatitis should be based on risk factors.
● Hepatitis C testing. This one-time testing is suggested for women who don’t their infection status and were born between 1945-1965.
● Pap smear. This cervical cancer screening should be performed every 3 years in women ages 21-30. In women who are over 30, a Pap smear and HPV test is recommended once every 5 years.
● Clinical breast exam. Once a woman reaches age 20, a breast exam by a health care provider is recommended every 1-3 years.
● Mammogram. A diagnostic imaging test used to identify abnormalities in the breast that have the potential to be breast cancer. This exam is more likely to result in false positives in younger women. For this reason, it is recommended that women in the 40’s discuss the benefits and risks with their provider and jointly decide whether or not they should start mammogram screening. By age 50, all women should be having mammograms every 1 to 2 years.
● Bone density testing. This exam is recommended for postmenopausal patients under 65 who also have risk factors for a bone fracture and all women who are 65 & up.
● Diabetes testing and lipid (cholesterol) profile assessment. A blood test can determine if a patient’s blood sugar and cholesterol are within a normal range. A provider will recommend tests periodically to their patients.
Advice for Patients
Patients shouldn’t be afraid or embarrassed to ask a question or discuss a concern with their provider. Sexual activity and function, vaginal health, body changes, STI testing, and bowel or bladder problems are all sensitive issues gynecologists deal with regularly. Chances are the provider has been asked the same question many times before. Information exchange with a provider should occur in a caring, compassionate, and strictly confidential environment. If a patient doesn’t feel this is the case with their provider, they should seek a different provider.
With all the ground to cover in an annual exam, it is sometimes challenging to address every concern in the time allotted. Accepting or asking for a return visit to focus more on a specific problem will ensure the patient gets the care they need and deserve. If a provider recommends the patient do additional testing, such as blood work or ultrasound, it is important they complete these tests and discuss the results.
Effective health care is a partnership between patient and provider. Having an annual gynecologic check-up before a patient has a problem is a great way to build a relationship with their provider.