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, the preventive gynecologic care they provide (including taking a history) may also be relevant for people who are gender diverse, depending on their anatomy, use of hormones, and individual health needs.
For gynecologic care, a woman should choose a health care professional with whom she can comfortably discuss and share decision-making regarding 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. It is recommended that the initial reproductive health visit occur between ages 13 and 15 years and focus primarily on education, preventive care, menstrual assessment, sexual health counseling, vaccination, establishing a trusting relationship, answering questions, and encouraging healthy behaviors. An internal pelvic examination is performed rarely and only when medically indicated.
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, but the frequency of visits may vary based on age, risk factors, symptoms, and individual needs. 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)
Mental health conditions, such as anxiety and/or depression
Social needs that may affect health (such as food insecurity or housing instability, when appropriate)
Additionally, during a well-woman visit, patients may be screened for or counseled about the following:
Sexually transmitted infections (STIs) and safer sex practices
Menstrual cycle and abnormal uterine bleeding (AUB)
Preconception care
Perimenopause and menopause
Osteoporosis (low bone density) screening and prevention
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 (such as pelvic pain, abnormal vaginal bleeding or discharge, or itching), 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. Whether pelvic examination is useful for detecting ovarian cancer, bacterial vaginosis, trichomoniasis, or genital herpes in symptom-free women has not been firmly established but may be performed if deemed necessary by both parties. A woman does not need a pelvic examination before using contraception, except for an intrauterine device. Routine pelvic examinations have not been shown to improve detection of ovarian cancer or several infections in women without symptoms.
Like the pelvic examination, whether to have a breast examination should be a shared decision between a woman and clinician. Age-appropriate and risk-based 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. Clinical breast examination is not recommended as the only screening test for breast cancer in average-risk women. Women should be familiar with the normal appearance and feel of their breasts and report any new changes promptly to their clinician.
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.
Future reproductive planning should be reviewed periodically and be used to help guide contraception, preconception counseling, and managing chronic disease, before, during, and after the pregnancy.
The gynecologic visit is a convenient time to ask a clinician questions about the following:
Reproductive and sexual function and anatomy
Safer sex practices, such as the use of condoms to minimize the risks of sexually transmitted infections
HPV vaccination, including catch-up protocols through age 26 years; from ages 27 through 45 years for others
Pre- and postexposure prophylaxis to prevent HIV infection before and after possible exposure to HIV (PrEP and PEP, respectively)
Postexposure prophylaxis for the prevention of syphilis, gonorrhea, and chlamydia (doxyPEP) after possible exposure to these STIs
More Information
The following English-language resources from the American College of Obstetricians and Gynecologists (ACOG) and the Centers for Disease Control and Prevention (CDC) may be useful. Please note that The Manual is not responsible for the content of these resources.
