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Routine Gynecologic Care

by David H. Barad, MD, MS

Preventive health care includes having regular gynecologic examinations, even when no symptoms are present, and screening tests. Screening tests are done before people have any symptoms to check for disorders that can be prevented or treated effectively if recognized early (see see Table: Some Recommended Screening Tests for Adults* ,†).

Women should have a gynecologic evaluation every year starting at about age 13 to 18. A pelvic examination is not usually done before age 21 unless there is a problem, such as irregular periods, pelvic pain, or a vaginal discharge. Doctors test sexually active adolescents for sexually transmitted diseases, sometimes without doing a pelvic examination. Pelvic examinations are recommended for all women, starting at age 21. However, a woman can talk with her health care practitioner about whether these examinations need to be started at this age. Also, at age 21, most women should start having tests to screen for cervical cancer, such as a Papanicolaou (Pap) test.

For gynecologic care, a woman should choose a health care practitioner with whom she can comfortably discuss sensitive topics, such as sex, birth control, pregnancy, and problems related to menopause. The practitioner may be a gynecologist, an internist, a nurse-midwife, or a general, family, or nurse practitioner.

Gynecologic evaluation of young and adolescent girls can sometimes be done by their pediatrician. However, if the pediatrician cannot set aside time for the girl to speak privately about personal concerns or is reluctant to provide gynecologic care, another health care practitioner should be found for this care.

The gynecologic visit is the time to ask the practitioner 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 diseases.

During a visit for gynecologic care, doctors ask questions (the history) and do a physical examination.