What happens at a well-woman visit?
The first part of your visit consists of your doctor or midwife asking you about your family and personal history. This may start in the waiting room, where you could be asked to fill out a form detailing your medical history, particularly if this is your first visit. Family history, including a history of cancer or diabetes in your immediate family, can indicate areas where you have an increased risk for disease; your doctor or midwife can order targeted tests for these conditions. Your personal medical history includes all prior illnesses, hospitalizations, surgeries and medications. Your midwife or doctor may also ask about lifestyle choices that can impact your health, including tobacco and alcohol use, diet and physical activity.
Another important part of the history is the sexual history, which includes your level of sexual activity and number of partners, as well as the use of condoms and contraception. While some women may feel uncomfortable with these topics, honest and open communication is important to make sure that you receive the best possible care. Your doctor or midwife will also want to know about your menstrual cycles and the details of any prior pregnancies. Finally, you can discuss any problems you might currently be having, including heavy menstrual bleeding, pelvic pain and vaginal discharge.
The physical exam
Your physical exam will likely start with the measurement of your height and weight, as well as your vital signs (temperature, blood pressure, heart rate). Most doctors or midwifes will perform a clinical breast exam, checking your breast for any abnormal lumps or changes in the skin. Your gynecological exam may consist of an external and internal component. The external exam is a visual inspection of the vagina to assess the anatomy and look for any lesions (like vaginal warts) that may need further evaluation or treatment. The internal exam involves the use of a speculum, a medical instrument that widens the vaginal cavity so the doctor or midwife can get a good look at the vaginal walls and the cervix, or opening to the uterus. This also enables a sampling of cells from the cervix, called a ‘Pap smear’ or a ‘Pap test’. You may also have a bimanual examination, in which you doctor places one hand on top of your abdomen and a couple of fingers inside the vaginal cavity, to check for any tenderness in your cervix or ovaries.
Based on your age, history and physical exam, your doctor may order one or more diagnostic tests. Most women will receive a Pap test every one to three years to check for cervical cancer; a sample is taken from your cervix during the exam and sent to the lab for evaluation. You typically receive the results within 1-2 weeks. Sexually active women may have a sample of their cervical fluid, vaginal fluid or urine sent to the lab to check for sexually transmitted diseases including gonorrhea and chlamydia. For women 40 years of age and older, a yearly mammogram is typically recommended. At age 65 and older, your doctor or midwife may order a bone mineral density test to check for osteoporosis. Your doctor or midwife may also check a urine sample, to check for infection, kidney disease and diabetes.
How does this all benefit me?
Catching problems before they get serious can make a major difference in your health. For example, Pap smears can detect precancerous cells in the cervix; these can often be treated with minimal procedures, resulting in a greater than 90% cure rate. In contrast, survival rates for undiagnosed advanced cervical cancer can be as low as 15%. Another example is the sexually transmitted disease, chlamydia; many women who contract chlamydia have no symptoms. However, left untreated, chlamydia can result in permanent damage to the uterus and fallopian tubes, leading to infertility, ectopic pregnancy and chronic pain. This makes the screening tests for chlamydia performed by your doctor vitally important.
Your annual well-women exam is your chance to be an active partner in your continued well-being. Together, you and your doctor or midwife can identify and treat any health problems, and make plans for your future health, including contraception or planning for the birth of a healthy child. Call us today to schedule your tune-up!