Regular gynecological visits are a cornerstone of preventive health care for women. Early detection and treatment of many gyn conditions can minimize their long-term consequences. Yearly breast and internal pelvic exams are recommended for all women after the age of 18, and a consultation should be scheduled sooner if sexual activity is being considered.
It is appropriate for adolescents to begin to build a patient-physician relationship with a gynecologist when they are 13-15 years old. The first visit is intended to establish a rapport with someone who, over time, may become a trusted source of women’s health care information. An internal pelvic exam is not typically performed. Once a young woman feels comfortable enough, an abbreviated exam including a breast exam, abdominal exam and visual inspection of the external genital area will be done.
The pap smear is a screening test that checks for pre-cancer of the cervix. In women 30 years old and older, the pap usually includes a test for HPV (Human Papilloma Virus), a sexually transmitted infection found to be the cause of cervical cancer. Rarely, the pap smear will identify an invasive cervical cancer. Usually pre-cancerous cells are found with more than enough time for treatment to prevent progression to cancer. Because it is a screening rather than a diagnostic test, pap smears can also be read as abnormal because of inflammation, infection, and/or atrophy (a result of decreased estrogen in the body). Sometimes there are really pre-cancerous cells but the changes are mild enough (low-grade changes) to be very likely to go away without treatment. High-grade changes are likely enough to worsen that treatment is recommended. An office procedure called colposcopy is the diagnostic test used to tell the difference.
As recommended by the American College of Ob/Gyn, the current pap smear screening guidelines for patients who have never had an abnormal pap smear are to have them done every 3 years starting at age 21, and then to decrease the frequency to every 5 years starting at age 30. They can be stopped completely in most woman who have had the cervix removed at the time of hysterectomy, and at the age of 65 for others. Patients who have had abnormal pap smears, with or without HPV, will have the frequency of their pap smears individualized for their particular circumstances.
Most women should start getting regular mammograms at the age of 40, every 1-2 years, with yearly testing recommended as of age 50. Having this important breast screening test before age 40 may be appropriate based on a woman’s specific personal and family history.
For information regarding the newest type of mammogram test, see 3D Mammography.
DEXA Bone Density Scans
This test to screen for bone loss (osteopenia and osteoporosis) should be done at age 65. It is not recommended sooner unless there are significant risk factors other than age alone. If the first DEXA is normal, it is very unlikely that osteoporosis will develop over the following 10 year period.
Initial screening colonoscopy is recommended for everyone at the age of 50, and sooner if indicated because of a positive family history in a parent or sibling. The frequency of later colonoscopy screening is then individualized based on the findings at the initial study and family history.
Because diabetes, high cholesterol and thyroid dysfunction are so common, regular labwork is recommended as follows:
a fasting glucose test every 3 years as of age 45,
cholesterol testing every 5 years as of age 45,
thyroid stimulating hormone (TSH) every 5 years as of age 50.
Please let us know if you would like us to order these tests for you.
More information regarding current screening recommendations can be found at www.ACOG.org.