When the U.S. Preventive Services Task Force issued guidelines in 2012 stating that most women over age 65 no longer need an annual Pap test to screen for cervical cancer, many women viewed that as reason not to keep their yearly gynecologist appointment. But is it wise for women to forgo their regular well-woman visits?
In a word, no, says the American College of Obstetricians and Gynecologists (ACOG), the national organization of women's health care physicians. In a Practice Opinion updated August 2012, ACOG stressed the importance of the annual assessment as a fundamental part of women's medical care.
Why so? While the incidence of cervical cancer decreases after age 55, a woman’s risk for other cancersuterine, ovarian and breastincreases with age. Other factors in your personal and family health history, such as whether you took hormone therapy or have a genetic risk for cancer, indicate need for continued surveillance.
What to expect at your visit
The scope of a well-woman visit varies from doctor to doctor, but for the most part, the visit includes these elements:
- Physical assessment. The exam typically includes an evaluation of your overall health, which includes taking vital statistics like blood pressure and body mass index (an indicator of whether your weight is at a healthy range for your height). The exam includes palpating the abdomen to look for masses or enlarged organs and checking the lymph nodes.
- Pelvic exam. A pelvic exam involves three parts: an external examination of the vulva, an internal examination of the vagina and cervix with a speculum, and an examination of the reproductive organs with a gloved hand. In some cases, you may not need the internal portion of the exam, depending on certain factors, such as if you are asymptomatic, are healthy and have had a hysterectomybut the decision not to be examined should be made together with your doctor. Many doctors will also perform a transvaginal ultrasound exam, which reveals valuable information about the ovaries and uterine lining.
- Pap test. Even though most women over 65 who've had three normal Pap tests in a row may no longer need a test, healthy women ages 21 to 65 who have had sexual intercourse and have a cervix still need a Pap test every three years.
- Clinical breast exam. Your provider will inquire about your medical history and family history of breast disease, discuss your own breast self-awareness and prompt you to schedule a mammogram. With your consent, he or she will perform a breast exam to check for lumps or other abnormalities. (ACOG recommends that women 40 and older have annual mammograms and clinical breast exams.) Your provider may also show you how to perform a breast self-examination.
- Evaluation of symptoms. Your gynecologist is uniquely qualified to assess any pelvic, urinary or rectal issues, such as pain or discomfort, vaginal dryness, urinary leakage or bladder or bowel changes.
- Screenings and vaccinations. Time for a bone density test or a colonoscopy? Did you get your flu shot or shingles vaccine? Your provider will likely discuss some aspects of preventive care such as these, based on your age and risk factors.
- Counseling. Expect a frank discussion about maintaining a healthy weight and active lifestyle. Your doctor will ask you what medications you're taking, if you've had any change in medications or whether you’ve had a bone fracture as well as inquire about your family's health history. He or she may also ask about your intimate relationships and sexual activity and satisfaction.
Your annual well-woman exam should be an essential component of your healthcare. The benefits of a yearly visit extend well beyond a Pap testand your doctor may be able to identify a medical problem that may otherwise go undetected.
Source: Prepared by the Editors of The Johns Hopkins Medical Letter: Health After 50