Preventive health care for women includes having a medical visit every year or every few years with a gynecologic examination and screening tests. Although these visits are typically called "well-woman" visits, preventive gynecologic care may also be relevant for people who are gender diverse.
For gynecologic care, a woman should choose a health care professional with whom she can comfortably discuss sensitive topics, such as sexual concerns, birth control, pregnancy, and menopause. The clinician may be a gynecologist, primary care physician, nurse-midwife, nurse practitioner, or physician assistant. Gynecologic evaluation of children and adolescent girls if needed can usually be done by the child's pediatrician.
Recommendations vary regarding the frequency of well-woman or primary care visits. The American College of Obstetricians and Gynecologists (ACOG) recommends well-woman visits every year for women who are sexually active or 18 years or older. ACOG recommends that these visits include screening, evaluation, counseling, and immunizations based on age and risk factors.
During a well-woman visit, clinicians ask questions (the history) and do a physical examination, usually including a pelvic examination. Vaccinations, including the human papillomavirus vaccination, may be offered.
General medical care during a well-woman visit may include counseling on general health, diet, and physical activity, and routine screening for the following:
High levels of cholesterol and other fats (dyslipidemia)
Domestic violence (intimate partner violence)
Additionally, during a well-woman visit, patients may be screened for or counseled about the following:
Safer sex and sexual health concerns
Menstrual cycle and abnormal uterine bleeding (AUB)
Preconception care
Perimenopause and menopause
Bone density
Whether to have a pelvic examination should be a shared decision between a woman and her clinician. Pelvic examinations may be recommended if a woman has symptoms of a gynecologic disorder, as part of routine preventive care screening, or if a woman expresses a preference for the examination after discussing the risks and benefits with the clinician. A woman does not need a pelvic examination before using contraception, except for an intrauterine device.
Like the pelvic examination, whether to have a breast examination should be a shared decision between a woman and clinician. Breast examinations may be recommended if a woman has symptoms of a breast disorder, as part of routine preventive care screening, or if a woman expresses a preference for the examination. With a woman sitting, the clinician inspects the breasts for irregularities, dimpling, tightened skin, lumps, and a discharge. A woman then sits or lies down, with her arms above her head, while the clinician feels (palpates) each breast with a flat hand and examines each armpit for enlarged lymph nodes and for lumps and abnormalities.
In addition to a breast or pelvic examination, a well-woman visit may include a general physical examination. The clinician may feel the neck and the thyroid gland to check for lumps and abnormalities. An enlarged, overactive thyroid gland (hyperthyroidism) can cause menstrual abnormalities. The clinician checks for other hormonal issues by examining the skin for signs of acne, abnormal body or scalp hair patterns (hirsutism), spots, and growths.
The clinician may do an abdominal examination and use a stethoscope to listen for activity of the intestine and to check for abnormal noises made by blood flowing through narrowed blood vessels. The clinician may tap areas of the abdomen with the fingers. The clinician gently feels the entire abdomen to check for abnormal masses (such as an umbilical hernia or tumor) or enlarged organs, especially the liver and spleen. Although a woman may experience some discomfort when the clinician presses deeply, the examination should not be painful.
The clinician may also check the groin for enlarged lymph nodes or hernia.
The gynecologic visit is a convenient time to ask a clinician questions about reproductive and sexual function and anatomy, including safe sex practices, such as the use of condoms to minimize the risks of sexually transmitted infections.
More Information
The following English-language resources from the American College of Obstetricians and Gynecologists (ACOG) may be useful. Please note that THE MANUAL is not responsible for the content of these resources.
