What to expect on your first women’s wellness exam – Forbes Health

During a healthy woman exam, your doctor will review all of your current medical issues and determine if there is anything missing in the care, Dr. Marchand says. It’s important to note that medicine is constantly changing, so recommended treatment can vary greatly in a single year, he adds. The doctor should examine you from head to toe, check your vital signs and determine if you need any vaccinations. The visit usually includes the following:

Medical history and physical examination

Upon arrival, you will undergo a routine physical examination which includes taking your weight, pulse and blood pressure. A urine sample may be requested to test for sexually transmitted diseases (STDs) and rule out urinary tract infections, says Dr. Alagia. “You will be asked to put on a gown after being left alone in the examination room. Once your healthcare professional walks into the room, they should take a few moments to review the test they plan to perform and explain the reason for the specific test,” he says.

You will have time before, after, and during the exam to ask and answer any questions you and your healthcare provider may have. It is helpful to prepare a list of questions in advance.

The questions your doctor asks will be tailored to your age and medical history, says Dr. Swarup. For example, they may ask if you smoke, use drugs or alcohol, have any allergies or infections, and if you’ve had any surgeries, he says — all of these factors can affect your reproductive health.

Your doctor may ask the following questions, according to Dr. Swarup:

  • When was your last period?
  • How often do your periods occur and how long do they last?
  • Is there any bleeding between your periods?
  • Is there any itching, pain or vaginal discharge?
  • Do you have any medical concerns?
  • Do any members of your family have any medical problems?
  • How often are you sexually active and have a new partner?
  • What kind of sex do you have? It’s painful? Do you ever bleed afterwards?
  • Do you use birth control?
  • Are you worried about being pregnant?
  • Are you trying to get pregnant?
  • What do you use to prevent sexually transmitted diseases (STDs)?

It’s important to be completely honest in your answers because the questions are good for your health, says Dr. Marchand. “Remember that a doctor can never share personal information about your visit (this could easily result in disciplinary action from the medical board or the loss of your license to practice),” he says. Doctors may share your information with other members of their healthcare team if it is necessary to provide your care or coordinate your care. Doctors may also share your information with your permission. Physicians may also share your information with law enforcement to prevent or mitigate a serious and imminent threat to the health or safety of an individual or the public. Dr. Alagia adds that having an honest dialogue with your healthcare professional helps them recommend guideline-based care such as STD screening, cancer screening, and other services.

You should also expect questions about your diet, life stressors and exercise habits, says Dr. Marchand. “Because screening for depression and anxiety is so important for all patients, you should be prepared to answer questions about how you are feeling,” he says.

Breast examination

Starting at age 20, a breast exam can be done every one to three years to identify any irregularities or lumps, Dr. Swarup says, but recommendations vary. For example, ACOG advises that clinical breast exams can be offered every one to three years for women aged 25 to 39 and once a year for women over 40.

The American Cancer Society does not recommend clinical breast exams or breast self-exams at all due to the lack of evidence that they do little to help detect breast cancer early when mammography is available. Currently, mammograms (x-ray images of the breast) are recommended annually for women over 45 and once every two years for women over 55.

ACOG offers women between the ages of 25 and 39 a clinical breast exam every one to three years and women over the age of 40 an annual exam. Either way, ACOG recommends that women make the decision that’s best for them.

If your practitioner performs a clinical breast exam, you’ll be asked to raise one arm behind your head, says Dr. Alagia. This allows your doctor to better examine each breast, applying light pressure in circular motions. “They will look for abnormal lumps or cysts. If any lumps are discovered, a biopsy will be ordered to determine if they are cancerous or not,” explains Dr. Alagia.

Pelvic exam

A pelvic or internal exam is done to check the vulva, vagina, cervix, fallopian tubes, ovaries, and rectum for abnormalities. Teenage girls do not need a pelvic exam unless they have abnormal bleeding, discharge, or pelvic pain. You are unlikely to have a pelvic exam before age 21 unless such symptoms are present. Although the exam may be uncomfortable, it should not be painful. Keeping your body relaxed will help minimize discomfort.

During a pelvic exam, your doctor will also examine your vulva and rectum for irritation, redness, or other concerning signs, says Dr. Swarup. A lubricated speculum is placed in the vagina to look inside, which allows the cervix to be assessed for signs of disease. After removing the speculum, your doctor gently inserts one or two fingers (using a lubricated glove) into your vaginal canal while applying gentle pressure to your lower abdomen, Dr. Alagia says. This allows them to check for abnormalities in the size, shape, and position of the uterus and ovaries.

You can expect to feel some pressure, says Dr. Alagia, adding that it’s important to communicate any feelings of pain, heaviness, bloating or tenderness — this helps your doctor understand potential causes for concern.

Cervical cancer screening

Depending on your age, you may be screened for cervical cancer with a Pap test and/or a human papillomavirus (HPV) test during your pelvic exam. A Pap test looks for cell changes in the cervix that can turn into cervical cancer, and an HPV test checks for the presence of human papillomavirus, the virus responsible for these changes.

Current guidelines from the US Preventive Services Task Force advise that women ages 21 to 29 be screened every three years with a Pap test alone; women aged 30 to 65 can be screened every three years with a Pap test only, every five years with an HPV test only, or every five years with both.

For HPV and Pap tests, your healthcare provider will insert a lubricated speculum into your vaginal canal to view your vagina and cervix, Dr. Alagia says. “They will wipe your cervix with a swab and send it to a lab to make sure there are no signs of cervical cancer and make sure your cervix uterus is healthy,” he says.

Screening for sexually transmitted diseases (STDs)

Even if you think you’re not at risk, you should discuss STD testing with your doctor, says Dr. Alagia. Currently, the Centers for Disease Control and Prevention (CDC) recommends the following testing schedule for STDS:

  • All adults and adolescents between the ages of 13 and 64 should be tested for HIV at least once.
  • All sexually active women under 25 should be tested annually for gonorrhea and chlamydia, and women over 25 with new or multiple sexual partners or a sexual partner with an STD should be tested annually.
  • Pregnant women should be tested for syphilis, HIV, hepatitis B, and hepatitis C early in pregnancy, and those at risk (new sex partners or multiple sex partners) should also be tested for chlamydia and gonorrhea.

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