Well woman or Annual exams is the pillar for prevention of chronic medical disease, identification and management of medical disease and the promotion of a woman’s health throughout her entire life. The promotion of exercise, healthy eating which consists of less animal protein and fat and more whole plant based foods healthy living leads to less chance of developing chronic diseases, but leads to a much longer lifespan and more importantly, your quality of living. A yearly annual well woman exam for all ages is not just about good medical care, but it also gives you the opportunity to learn more about beneficial healthy health habits, community support services that are available, and to assure that patients are on the right track of taking care of themselves and their families, as well as an overall view of the best ways to take care of yourself and your family for a lifetime.

The Well Woman or Annual Exam consists of several important parts: 1) the medical history, 2) a physical exam which includes the patients vital signs (Blood Pressure, Pulse Rate, Respirations, and Temperature, Head, Ears, Eyes and nose, listening to the lungs and heart, abdominal exam including palpating for enlarged organs such as the liver and spleen, a breast exam, pelvic exam and other lab work depending on patient risk factors, symptoms, and age.

Health Services Offered

Women’s health services offered include

Primary Care and Preventative Services

  • Routine assessment for women of all ages
  • Health evaluation and counseling for
    • Nutrition
    • Exercise
    • Diminish Mental Stress
  • Cardiovascular or heart disorders
    • Autoimmune Disease
    • Cancer
    • Elevated Cholesterol and Triglycerides
    • Drug Abuse
    • Arthritis
    • Thyroid disorders
    • Smoking
    • Hypertension

Family planning—Using Birth control method that works best for each person, spacing of children, prevention of Sexually Transmitted Diseases.

Preconception care—planning pregnancy is important to a healthy mom and baby: i.e. prevention of neural tube defect, nutritional care, Diabetic with uncontrolled sugars that can lead to severe congenital anomalies unless the blood sugars are brought under control prior to conception.

Midlife Management

  • Perimenopause (symptoms start about age 40)
  • Menopause (average age 51)

Gynecology

  • Initial and periodic evaluation and treatment of health problems including breast conditions
  • Surgery services
  • Incontinence (uncontrolled urination)
  • Ultrasound
  • Evaluation and treatment of menstrual problems and infertility
  • Referral to other healthcare providers for necessary care

When should Pap smears be performed?

ACOG recommends women to have a physical exam which includes a pelvic exam with a pap smear, by age 21 unless they are sexually active. For sexually active women, this exam is recommended approximately three years after the first sexual encounter no matter what age that occurred. Women, younger than 21 who are not sexually active, but are having gynecological problems, should seek care if symptoms are severe or do not improve. Women are recommended to have yearly Pap Smears up to age 30 and if all test results are negative, then the screening can be extended to every three years. After age 70, there is no need to continue to perform Pap Smears as the incidence of cervical cancer after that age is minimal.

What should be the medical history include?

The first office visit as a new patient could last a lot longer than other visits because of having to go over a lot of information which your care provider is having the first opportunity to see and discuss with a new patient. A detailed history consists of a complete review of medical systems, family history, psychological, social, gynecologic and obstetric history.

You should bring recent medical records and a written list of medications that you are taking as well as those that you are allergic to. You may discuss things that you are not comfortable talking about to others as this is privacy issue between you and your Physician. Depressed, not sleeping well, lack of interest in sex, domestic violence, drug and alcohol abuse, rape, and other issues should be discussed. It is not unusual for women to write down a list of questions to ask the Physician so they will not forget.

The Physical Exam

The physical exam is totally through and gives clues to any health problems. Temperature, weight, pulse, respirations, blood pressure, urine testing, cholesterol, lipid panel, and a check for anemia often are done. Your care provider likely will examine eyes, ears, nose, mouth, thyroid gland, lungs, lymph nodes, heart, breasts, abdomen, reflexes, skin and bone and spine

Breast Exam

An important part of the yearly well woman or annual exam is the breast exam. It is done to look for evidence of benign or potentially malignant disease. The exam begins by sitting up with arms above the head for any signs of an abnormal look to the breast such as redness, swelling, itching or scaling of the nipple, a sudden nipple discharge, nipple inversion, peau d’orange (orange peel) appearance of breast. The Physician will examine each breast with the tips of the three middle fingers searching for nodules or thickening of the breast including underneath the arm pits.

You will then lie on the exam table and perform the same breast exam looking for the same abnormal findings including squeezing of the nipple checking for a nipple discharge.

Pelvic Exams

The pelvic exam specifically determines if the outer perineum, vagina, vulva, labia, and inner pelvic organs are normal and without disease. To do this, your care provider will look at the outer area for any problems. Once examining the external portion of the pelvic female organs, a speculum is inserted inside the vagina which allows the vaginal walls to remain open while the inside of the vagina and the cervix can be visualized and examined looking for any abnormal discharge or discoloration , or other evidence of infection occurring. This part of the exam should only cause pelvic pressure but no pain.

An annual Pap Smear to detect abnormal cell changes of the cervix that can lead to cervical cancer normally occurs unless the patient had a recent Pap Smear with the lab results that can be documented. This involves scraping the external and internal area of the cervix with a brush. The speculum is then removed and a bimanual examination of the pelvis is then performed where two fingers are inserted into the vagina after lubrication is placed on the gloved fingers. The outer hand presses down on the lower abdomen and pelvis bringing the uterus and ovaries together between the internal and external hands and fingers.

Lab Tests

Sexually transmitted diseases (STDs) are on the increase in the United States. Chlamydia is the number one STD in women ages 15 to 28 with over 50 percent of women not having any symptoms. The problem is that it can lead to Pelvic Inflammatory Disease (PID), chronic pelvic pain, and infertility. It is highly recommended that women less than 30 years old have yearly Chlamydia cultures performed along with women who have multiple sexual partners, or new partner and don’t use condoms. Condoms do not 100 protect patients getting STD’s.

A Woman may not be aware that they are infected since she may display no symptoms. For this reason, women at any age with a history of risky behavior (multiple sexual partners, not using protection when engaging in intercourse, new sexual partner) or evidence of problems, may need culture swabs, special urine tests, or tests that can be read in 20 minutes to determine the presence of gonorrhea or Chlamydia. Cultures involve swabbing the cervix and vagina with a small cotton swab. Non-sexually transmitted diseases such as bacterial vaginosis, and vaginal yeast infections and STDs—Trichomoniasis, Chlamydia and gonorrhea—can be tested in this way. These infections all easily are treated with medications.

If you are concerned about diseases such as syphilis, herpes, HIV or hepatitis, please let your provider know. Testing is available by collecting a vial of blood and in some cases only a drop of blood is necessary.

Midlife and Beyond

Since Obstetrics & Gynecologist are the only primary specialist that women see on a yearly basis, it is important for women to be screened for chronic diseases during the well woman visit such as heart disease, stroke, cancer, diabetes, thyroid, liver and kidney disease. With these in mind, some issues your healthcare provider should address include the following.

  • The incidence of depression rises in older women and questions and signs of this should be addressed.
  • A recent study questions whether or not annual mammograms should be done for women 40 or older. It seems that they may be only needed every 2 or 3 years. The combination of monthly breast self exam, annual clinical breast exam by your doctor greatly improves early detection and survival of breast cancer.
  • A screening colonoscopy, usually performed with general anesthesia in the hospital outpatient area for detection of colon cancer, is recommended for all women at age 50.
  • Women more than 65 years old or those younger with risk factors, should be tested for the bone disease called osteoporosis with a DEXA scan. This is a quick and painless X-ray, usually of the hips and spine, using a very small amount of radiation that identifies your risk for broken bones as a result of bone thinning. Many new and good medications currently are available to treat this disorder if necessary.

In summary the well woman exam or annual exam is able to screen and identify potential problems or disease throughout the patient’s life and reduce the incidence of morbidity and mortality through prevention and early treatment. It is becoming more important for women to take care of themselves and their families.

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