The focus of your gynecologic exam will evolve as you age. Talking openly with your OB/GYN during your annual visit will ensure that you get what you need at your stage of life.
By Diana Price
Do you see your gynecologist each year for an annual exam? For many women various guidelines released by medical organizations over the past several years—which have included differing opinions about the value of annual pelvic exams,1 conflicting statements related to the recommended frequency of mammograms,2,3 and updated Pap test schedules4—have caused some confusion about whether an annual exam is necessary and what should be included in the visit.
The recommendation against regular pelvic exams, issued by the American College of Physicians in 2014, and the mammography schedule released by the US Preventive Services Task Force,5 which pushed the start to annual mammogram screening to age 50 (from 40), were both based on evidence that the risks associated with these preventive screenings may outweigh the benefits for healthy, low-risk populations.
Lauren Streicher, MD, associate clinical professor of obstetrics and gynecology at Northwestern University’s Feinberg School of Medicine and author of The Essential Guide to Hysterectomy: Advice from a Gynecologist on Your Choices before, during, and after Surgery (M. Evans, 2013; $22.95) and Sex Rx: Hormones, Health, and Your Best Sex Ever (Dey Street Books, 2015; $15.99), says that when evaluating these recommendations and planning medical care, women should remember that “these are not rules; they are recommendations from various organizations” and that each woman should consider her own needs and her and her family’s medical history to determine when and with what frequency to see her gynecologist.
As part of that decision-making process, Dr. Streicher says, women should be aware of the many benefits of an annual exam with an obstetrician/gynecologist (OB/ GYN)—and the risks of avoiding the visit. “Conflicting guidelines can be confusing, but putting off an appointment until you experience symptoms of some kind is not a good idea.”
This is because, according to Dr. Streicher, a thorough gynecologic exam includes a lot more than a Pap test. “A lot of women aren’t aware of all the components of an exam: I’m looking at the vulva [the external opening of the vagina] to screen for precancers and lesions; I’m examining the cervix and also the walls of the vagina and the tissue integrity; I’m looking for abnormal discharge; and I’m conducting a bimanual exam to check for any pelvic masses.”
The American Congress of Obstetricians and Gynecologists (ACOG) recommends that women begin seeing a gynecologist in their teens (age 13 to 15) and continue annually. ACOG guidelines6 for this annual visit include a general exam (height, weight, and body mass index, or BMI); a breast exam; a pelvic exam (with or without a Pap test); blood, urine, and screening for sexually transmitted diseases (STDs); bone mineral testing; colorectal cancer screening; and appropriate diabetes and heart health tests as necessary.
If you haven’t had an annual exam recently, or if you are planning for your next regular visit, Dr. Streicher offers the following discussion topics to address, in addition to those recommended by the ACOG, based on your age and stage in life.
Though this decade can be a time of transition for many women, establishing and maintaining regular visits with a gynecologist in your twenties can help you make good choices for long-term gynecologic health. Dr. Streicher recommends the following priorities for care.
For many women gynecologic visits in this decade revolve around fertility—contraception, pregnancy, and fertility preservation. “During your thirties we focus on timing— what we can do to get ready to be pregnant or, if you’re not ready to get pregnant, fertility preservation,” Dr. Streicher says.
For some women the forties may be a time when the annual visit takes a backseat to the demands of family and professional responsibilities, or the visit is postponed because of the perception that if annual Pap tests aren’t recommended, the visit isn’t as necessary. But Dr. Streicher cautions again that women should be aware of the additional areas an exam covers: “If a woman hasn’t seen a gynecologist in three years because she hasn’t needed a Pap test, she won’t have had STD screening, she may have fibroids or other issues that haven’t been examined, and we won’t see her until she has symptoms of some kind that could have been detected earlier through an annual exam.”
Here are the topics to be sure to cover in conversations with your gynecologist in your forties.
Menopause is the central gynecologic health concern for most women in their fifties, according to Dr. Streicher.
Sixties and Beyond
As women’s lives remain increasingly full through later years, careful care for sexual health and lingering menopausal symptoms is important. “The idea that menopause issues are over by this time is just wrong,” says Dr. Streicher. “Vaginal dryness persists and gets progressively worse, hot flashes remain an issue, and we start to deal with incontinences, urinary prolapse, and vulvar issues through the sixties, seventies, and eighties.”
Prepare for Your Appointment—and for the Possibility That You May Need to Book Another
There’s no doubt that, if comprehensive, an annual exam covers a lot of territory. Not only is your physician performing a thorough gynecologic exam, she or he is also talking to you about your overall health and related emotional well-being.
Prepare for the exam in advance by writing down any specific questions you have, with as much detail as possible, and passing that directly to the physician. But, Dr. Streicher notes, be aware that if you have specific concerns that warrant further discussion or examination, you will likely need to book a follow-up appointment.
“Generally, you have about 15 minutes allotted for the annual exam. That’s just not enough time to go into much depth about any one issue,” Dr. Streicher says. “Do yourself a favor and book a separate appointment so that you can get the care you need.”
1. Qaseem A, Humphrey LL, Harris R, Starkey M, Denberg TD, for the Clinical Guidelines Committee of the American College of Physicians. Screening pelvic examination in adult women: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine. 2014;161(1):67-72. doi: 10.7326/M14-0701 http://annals. org/article.aspx?articleid=1884537.
2. Breast Cancer: Screening. US Preventive Services Task Force website. Available at: http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/ breast-cancer-screening1. Accessed August 1, 2016.
3. Oeffinger KC, Fontham ET, Etzioni R, et al. Breast cancer screening for women at average risk: 2015 Guideline update from the American Cancer Society. Journal of the American Medical Association. 2015;314(15):1599-614. doi: 10.1001/ jama.2015.12783.
4. Cervical Cancer: Screening US Preventive Services Task Force website. Available at: http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/ cervical-cancer-screening. Accessed August 1, 2016.
5. Statement on ACOG’s Consensus Conference. Screening US Preventive Services Task Force website. Available at: http://screeningforbreastcancer.org. Accessed August 1, 2016.
6. Your Annual Healthcare Visit. American Congress of Obstetricians and Gynecologists website. Available at: http://www.acog.org/About-ACOG/ACOG-Departments/ Annual-Womens-Health-Care/Your-Annual-Health-Care- Visit. Accessed August 1, 2016.