One of the mainstays of preventive health for women is the ‘well-woman exam,’ the annual check-up that includes a pelvic and breast exam. However, since the American College of Obstetricians and Gynecologists revised screening guidelines for pap smears, calling for them as long as five years apart under certain circumstances, some women are under the impression that they have no reason to see the doctor for their annual exam. Not so.
“It is important to realize that the annual exam is more than a pap smear,” says Dr. Jennifer McDonald, an obstetrician and gynecologist on staff at Missouri Baptist Medical Center. “Many women are under the impression that pelvic exam and pap smear are synonymous; when, in fact, they are two different things.”
Pap smears involve taking a sample of cells from the cervix for laboratory analysis. Abnormal results may indicate cervical cancer or precancerous changes that require treatment. “The pap smear guidelines currently call for once every three years in the age group 21 to 30,” says Dr. Greg Ward, a SLUCare gynecologist who is director of the division of general obstetrics and gynecology at Saint Louis University.
“In the age group from 30 to 65 when we do the pap smear, we also test for human papillomavirus; and if both are negative, you can space the pap smear out to five years. Be we still like to see patients yearly.” Ward notes that a well-woman exam should continue to include a pelvic exam using a speculum “to visually inspect the cervix, as well as the vagina.”
The well-woman exam also is an opportunity to ensure you are current on all immunizations, arrange for other recommended screening tests such as cholesterol screening and mammograms, and bring up any health concerns or questions you may have.
“Women should be prepared to share all aspects of their health and reproductive history with their clinician,” McDonald says. “While sometimes, portions of a health history may be difficult to discuss or regarded as embarrassing by the patient, such as a history of sexually transmitted disease, miscarriage, elective terminations, etc., it’s important that the women’s health-care provider have the right information to provide comprehensive care.” And since all information shared is subject to strict confidentiality rules, patients should realize that the doctor is one of only a few people legally bound to protect their privacy.
“From the physician’s standpoint, this is a fundamental part of providing care. It’s valuable in providing prevention practices, it allows us to recognize risk factors for other diseases, it allows us to identify medical problems, and it helps establish a good clinician-patient relationship,” Ward says. He recommends bringing a comprehensive list of all medications and supplements, and the amounts you currently take, as well as a detailed family health history to help in calculating various disease risk factors.
“As women move through life, their needs and concerns will change,” McDonald notes. “Often, the relationship between the patient and her women’s health care provider spans many decades—what a wonderful opportunity for both parties.”