Why Women Need Annual GYN Exams
As cervical cancer screening recommendations have changed in the last few years, women were thrilled to learn they no longer needed a Pap smear every year. Even if you only need that test once every 3 to 5 years, you should still visit your gynecology provider annually!
The annual GYN exam is performed by a medical provider with specialized training in gynecology; this may be a gynecology physician, primary care physician, nurse practitioner, certified nurse midwife, or physician assistant. The benefits of a yearly visit extend well beyond a Pap smear. Annual gynecologic exams are among the most important ways for women to receive preventive health screening and education that is specific to women.
Your provider is trained to care for women from adolescence through older age and understands a woman’s changing health care needs. He or she can address:
- birth control
- sexually transmitted infection (STI) screening and prevention
- vaginal infections
- menstrual problems
- pelvic pain
- sexual function
- preconception counseling
- menopausal symptoms
- bone health
- urinary leakage
- breast changes
Many of the conditions that affect women’s health, including the human papilloma virus (HPV), cervical cancer, and breast cancer, can exist without any signs or symptoms. Regular screening with GYN exams and tests can detect these conditions at earlier stages when they can be treated most effectively.
Additionally, providers counsel on ways to stay healthy including diet, exercise, smoking cessation, mental health, and vaccinations.
What to expect
The exam starts with your provider collecting a comprehensive medical history including your family history. Vital signs like your blood pressure, heart rate, height, and weight will be measured. You will also be asked about your periods, pregnancy history, sexual activity, contraception needs, history of GYN problems, history of GYN surgeries, and any current symptoms you are having.
Your provider will listen to your heart and lungs, feel the thyroid gland in your throat, and feel your abdomen. You will also have a breast and pelvic exam. The pelvic exam consists of three parts: an external examination of the vulva, an internal examination of the vagina and cervix with a speculum, and an examination of the uterus and ovaries with a gloved hand. During the speculum exam, cells may be gently brushed from the cervix and sent to the laboratory for examination; this is a Pap smear. The exam will also focus on evaluating any symptoms you may be experiencing. If you find the pelvic exam extremely uncomfortable or anxiety-provoking, tell your provider. Relaxation strategies, repositioning, and using a smaller size speculum may improve your experience.
Finally, you and your provider will discuss ways to improve your health including lifestyle changes, screening tests, or vaccinations based on your age or other risk factors.
When to start GYN exams
The American College of Obstetricians and Gynecologists (ACOG) recommends that a first visit to a GYN provider take place between the ages of 13 and 15. This visit will probably not involve a pelvic exam, but rather will focus on education. Topics will include:
- normal development of sex organs
- positive habits like balanced nutrition, maintaining a healthy weight, and avoiding cigarette smoking
- preventing sexually transmitted infections (STIs)
- services related to birth control, STI testing, and HPV vaccination
ACOG recommends that pelvic exams, including a Pap smear, start at age 21, whether or not a woman has become sexually active.
There is not a set age for discontinuing GYN exams, although Pap smears may be stopped for low risk women ages 66 and older. A woman’s decision to stop having GYN exams should be made after a discussion with her provider. There are certain things to consider, including if your uterus and ovaries have been removed or you have a history of GYN conditions that require continued monitoring.
Preparing for your exam
Ideally, when a Pap smear is to be performed, try to schedule your annual exam when you are not having your period. Additionally, it is helpful to avoid vaginal activities such as douching, intercourse, or use of vaginal creams or medications for 48 hours prior to the test.
Bring a current list of medications and allergies, names of other providers who care for you, and any medical issues you have, including a history of surgeries and hospitalizations.
If you are experiencing abnormal bleeding or pelvic pain, a log of when these symptoms occur may be helpful to your provider.
Questions to ask your Provider
Any health-related question is fair game. There are some things a woman should definitely bring to the attention of her provider. Those include:
- pelvic pain or bloating
- missed periods
- abnormal bleeding, including heavy periods, bleeding in between periods, or bleeding after sex
- painful intercourse
- unusual vaginal discharge
- vulvar changes
- problems moving bowels or passing urine
- menopausal symptoms
- any breast concerns, such as pain, lumps, puckering, or nipple discharge
Screening tests are designed to detect hidden disease in otherwise healthy people. The types and frequency of recommended tests vary depending on a woman’s age, personal 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 your lifetime. However, your 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 recommended for women who were born anytime from 1945 through 1965 and who are unaware of their infection status.
- Pap smear. This cervical cancer screening should be performed every 3 years in women ages 21 to 29. In women who are 30 and older, co-testing of Pap smear and human papilloma virus (HPV) is recommended every 5 years.
- Clinical breast exam. A breast exam by a health care provider is recommended every 1 to 3 years beginning at age 20.
- Mammography. This diagnostic imaging test is used to identify abnormalities in the breast that could be breast cancer. This exam is less sensitive in younger women than in older woman and is more likely to result in false positives or over-diagnosis in younger women. For this reason, it is recommended that women ages 40 to 49 years discuss the benefits and risks with their provider and jointly decide whether to 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 all women ages 65 years and older or in postmenopausal women who are younger than 65, but have risk factors for a bone fracture.
- Diabetes testing and lipid (cholesterol) profile assessment. A blood test can determine if your blood sugar and cholesterol are within normal limits or if they need to be addressed. They should be recommended periodically by your provider.
Words of advice
Do not be afraid or embarrassed to ask a question or discuss a concern with your provider. Sexual activity and function, vaginal health, body changes, STI testing, and bowel or bladder problems are all sensitive issues he or she deals with regularly. Chances are your provider has been asked the same question many times before. Information exchange with your provider should occur in a caring, compassionate, and strictly confidential environment. If you don’t feel this way, you should seek a different provider.
With all the ground to cover in an annual GYN exam, it is sometimes challenging to address all of a woman’s concerns in the time allotted. Accepting or asking for a return visit to focus more on a specific problem will ensure you get the care you need and deserve. If your provider sends you for additional testing, such as blood work or an ultrasound, it is important to complete these tests and discuss the results in person or by phone.
Effective health care is a partnership between you and your medical provider. Having an annual gynecologic check-up before you have a problem is a great way to build a relationship with your provider!
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About the Author:
Melanie Hill, RNC, MS, WHNP-BC
Melanie Hill is a nurse practitioner in gynecologic oncology in the Center for Gynecologic Cancers at the Women’s Medicine Collaborative. She specializes in gynecologic oncology, management of abnormal Pap smears, and therapies for menopause symptoms.
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