Why is this important?

The annual exam is an opportunity for your certified nurse midwife, woman’s health nurse practitioner, or ob/gyn physician to physically assess, screen and evaluate your health and provide counseling on preventive care based upon your age and risk factors.  Although you don’t need a pap every year, you should have an annual exam. It is also a wonderful opportunity to develop a long-term relationship with your provider, as you may choose to see this provider throughout your life span for birth control, pregnancies, and postmenopausal care.

Who needs an annual exam?

All females beginning at age 13 should start having an annual physical exam.  The exam, screening, immunizations, and counseling will vary based upon age and risk factors.       

What happens during an annual “well woman” exam?

The annual exam is composed of an update of your health history, a physical exam, laboratory or other testing, and evaluation and counseling.

The health history may include questions about your health status based upon your medical, surgical, menstrual, and reproductive history. Questions about family medical history may also be asked. Questions related to your nutritional habits, physical activity, your sexual practice and orientation, number of sexual partners, use alcohol, tobacco, or other drugs, and abuse or neglect may be discussed. (ACOG, 2012)

The physical exam may include measuring your height, weight, body mass index (BMI), and blood pressure, assessing your thyroid gland on your neck, palpating your lymph nodes, listening to your heart and lungs, and examining your abdomen. A clinical breast exam may be performed on women every one to three years beginning at age 20, and every year beginning at age 40. (ACOG, 2012)

What about the pelvic exam, what is it and do I have to have one?

The pelvic exam includes an inspection of the outside of female genitalia, an inside exam using a speculum, and an inside/outside exam called the “bimanual exam” to feel the cervix, uterus, and ovaries.  (ACOG, 2012)

There is limited data on when and how often to have a pelvic exam done. The American College of Obstetrics and Gynecologists (ACOG) recommends that a pelvic exam be done for women every year beginning at the age of 21.  However, women who do not have any signs or symptoms of vaginal discharge, problems with their periods, or pelvic pain may not need a pelvic exam. The decision whether to do a pelvic exam or not can be made together between the patient and their provider based on your symptoms and risk factors.  Tests to screen for sexually transmitted infections can now be done with your urine or vaginal swabs without a speculum exam.  Women do not need a pelvic exam before starting on birth control. (ACOG, 2012)

Laboratory and other tests vary based upon your age and risk status. The labs or tests may include screening for cervical cancer based upon your age, and screening for sexually transmitted infections. Other tests based upon your age and if you have other high risk medical factors may include: mammograms, bone mineral density testing, colorectal cancer screening, diabetes screening, lipid/cholesterol testing, thyroid testing, hepatitis C virus testing, and tuberculosis skin testing (PPD).  (ACOG, 2012)

Evaluation and Counseling may include family planning (birth control or preconception planning), prevention of sexually transmitted disease, weight management for obesity or prevention of obesity (nutrition and exercise counseling) and evaluation for eating disorders, use of calcium, vitamin D and folic acid as nutritional supplements, mental health evaluation (stress, depression symptoms, behavioral health counseling), skin cancer awareness (exposure and ultraviolet rays), breast exam awareness, hygiene, and smoking cessation counseling. Your provider may also refer you to another provider such as a dermatologist or dietician when indicated. (ACOG, 2012)

Although we don’t need a pap every year we do need annual “well woman” exams. Please make an appoint with your HealthNet provider for your annual exam, so that we may help your understand your body, your risk factors, and help you achieve overall better health. Cheers and happy New Year to all!

For more information about HealthNet’s OB/GYN services, please visit www.indyhealthnet.org. 

Did you know January is Cervical Cancer Awareness Month? Honor Cervical Cancer Awareness Month by educating yourself on cervical cancer and how you can help protect yourself. HealthNet Certified Nurse Midwife, Carrie Bonsack teaches you everything you need to know about cervical cancer and answers some of the most common questions!

A pap smear is a test used to screen for cervical cancer. Many of you have had a pap smear every year since you were a teenager. Well, those days are over. It’s a new year and time for celebration that we are all done with yearly pap smears!  Some women are worried and feel they need a test every year, but let me reassure you that you do not need a pap smear every year.  Read on to find more about pap smears, HPV, and the importance of an annual “well woman” exam.

Why do I no longer get a Pap smear test every year with my annual exam?

In March of 2012, new pap screening guidelines were developed by the United States Preventive Services Task Force (USPSTF) and the American Cancer Society, American Society for Colposcopy and Cervical Pathology, American Society for Clinical Pathology (ACS/ASCCP/ASCP) based upon the woman’s age.  Basically, all of these organizations looked at research evidence and found that women do not need yearly pap smears and here is why:

• Cervical cancer is rare, especially in young women.
• Precancerous cells are caused by HPV and it will go away in most young healthy women.
• Testing for cervical cancer may lead to more treatment (more tests, more biopsies, and more surgeries) than necessary and may be doing more harm than good.
• Over treatment may lead to unnecessary short-term anxiety or concern.
• Over treatment may lead to pain, bleeding, or vaginal discharge after certain procedures.
• Over treatment may lead to problems with future pregnancies such as preterm birth and low birth weight babies.
  (Moyer, 2012)

When do I start getting screened for cervical cancer?

A woman should begin having a pap smear at the age of 21. Women between the ages of 21-29 should have a pap smear every three years. Women ages 30-65 should have either a pap only every three years or pap with HPV screening every five years. Women under the age of 21 should not have a pap.  (USPSTF/ACS/ASCCP/ASCP, 2012)

When do I stop getting screened for cervical cancer?

If you are age 65 and have had three negative pap smears in a row or two negative pap with HPV tests within ten years, or have no history of CIN 2 within the past twenty years, then you can stop having pap smears. (USPSTF/ACS/ASCCP/ASCP, 2012)

What is Human Papillomavirus (HPV)?

HPV is the most common sexually transmitted infection among both men and women. HPV more commonly infects the genital area, but can also infect the mouth or throat. Nearly everyone who is sexually active will get HPV at some point in his or her lifetime because it is so common. Around 90% of HPV infections can clear on their own within two years.  There are over 100 different types of HPV and some can cause genital warts and certain cancers, such as cervical cancer.  (CDC, 2013)

 Can I prevent HPV?

HPV vaccines can help prevent certain types of HPV, and are available and recommended for 11 and 12 year old boys and girls. Gardasil, an HPV vaccine, is available for males and females. Cervarix is available for females. Women, men, boys and girls between the ages of 13 and 26 can also get these vaccines if they did not get it when they were younger. The HPV vaccines are a series of three shots given over a six-month period.  Condoms can help protect against HPV when used from start to finish of the sex act, however, HPV can infect areas not covered by a condom.  Limiting your number of sex partners can decrease your risk of sexually transmitted infections. (CDC, 2013)