The Well Woman Exam
Well woman exams are the foundation for wellness, health promotion and disease identification and management throughout your life. It is no secret that healthy living and early detection of disease increases not only your length of life but, more importantly, your quality of living. A periodic 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 health habits, counseling and community support services as well as an overall view of the best ways to take care of yourself and your family for a lifetime.
The well women exam basically is performed in four parts: the health history, physical exam including a breast exam, pelvic exam and an assessment for other health problems. Always remember to discuss all healthcare issues with your care provider—your best source for advice on healthy living.
Women's Healthcare Services Include:
Primary and Preventive Services
Primary and preventative services include routine assessment for women of all ages, health evaluation and counseling for fitness, nutrition and exercise.
Routine Detection and Prevention of Disease
Whether you are planning the birth of a child or suffering symptoms of diseases, the Center for Women’s Health wants you to have the most up-to-date information on health conditions, symptoms and treatments.
Family Planning and Pre-conception Care
Whether you are expecting a baby or trying to conceive, the Center for Women and Infants can help you make the vital decisions necessary through your journey. Our physicians and staff are highly trained for prenatal care services, labor and delivery and high-risk perinatal services.
Who should have Pap smears and when?
The American College of Obstetricians and Gynecologists (ACOG, 2004) recommends that young women have a complete physical exam that 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.
Until age 30, ACOG recommends that all women have yearly pap tests. After age 30, if a woman has a negative history of abnormal pap smears for three years and no evidence of a virus called HPV, cervical screening can be extended to every three years unless they are at high risk for cervical cancer. Human papillomavirus (HPV) is a sexually transmitted virus that is responsible for genital warts, cervical cell abnormalities and, in some cases, cervical cancer. There are treatments available if HPV is detected, and often it clears up on its own.
Women who have had hysterectomies (removal of the uterus and often the ovaries) should know that ACOG suggests that if a hysterectomy was done for health reasons that did not include abnormal cells and cancer, they do not need pap smears. After age 70, the American Cancer Society suggests that pap smears are no longer necessary. It is important to know that ACOG advises all women to continue yearly pelvic exams even though they may not need a pap smear.
If you are establishing care with a new healthcare professional, your first visit may be longer and more involved than later office visits. Since your care provider is not familiar with you, a detailed medical, family, obstetric, gynecologic, genetic and psychosocial history is done to develop a complete plan of care. This is called the health history. It is important to know your family medical and genetic history, if possible. Some questions you will need to answer include
- Have you ever been pregnant and, if so, did you have any problems?
- Are you planning a pregnancy?
- Are you experiencing any health problems now?
- Are you up-to-date on shots?
- What about eating habits and exercise?
- Are you smoking?
It always is a good idea to bring any medical records and a list of medications that you may already be taking to your first health visit. Remember to include any use of alternative treatments such as herbal preparations or acupuncture.
The well woman exam is a good opportunity to discuss any concerns that you may not feel comfortable talking about with friends or family such as infection, drug and alcohol use, depression and domestic violence. Any health information you reveal is kept confidential, by law, so be sure to ask your care provider about any concerns. It always is a good idea to write down any questions you have and bring your list with you. Remember, no question is stupid. Your care provider wants to make sure you receive a complete plan of care in order to help you be healthy in every way.
The physical exam is a head-to-toe exam that gives clues to any health problems. Blood pressure, weight, urine testing 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. Any problems that are noted may need referral to another care provider. Eye and dental care is a must for overall health, too, and you should seek routine care for these health issues.
A Breast Exam, performed by your provider, is a very important part of the yearly well woman exam. It should be done for women of all ages to look for any evidence of breast disease. A good exam starts by sitting up with arms above the head for any signs of an abnormal look to the breast such as dimpling, nipple inversion (where the nipple turns in, not out), an orange peel appearance or any redness, soreness, rash or swelling. Your provider will touch each breast with the pads of the three middle fingers for evidence of lumps or thickening from the bottom of the breast to the collar bone and up under each arm pit. This area is all breast tissue and needs to be checked.
When, you lie down, the exam is performed again, looking for the same abnormal findings. Nipple discharge is important to access and a gentle squeeze on each nipple is done for this purpose. Even though you may have a negative clinical breast exam, you should continue monthly breast self-exams, performed the same way, in order to give yourself the best protection against breast cancer.
The pelvic exam specifically determines if the outer sexual parts (vulva and labia) and the inner organs (vagina, cervix, uterus and ovaries) are healthy. A Pap smear is done as part of a gynecological exam. To do this, your care provider will look at the outer area for any problems then gently insert a sterile instrument called a speculum into the vagina, in order to see the entire vagina and the lower part of the uterus called the cervix. This allows your care provider to observe any abnormal discharge or appearance to the vagina and cervix. Try to relax. You should feel some pressure during the procedure, but no pain.
An annual pap smear is done to detect abnormal cell changes of the cervix that could lead to cancer may be done at this time. This involves scraping the outer and inner area of the cervix with a small instrument called a palate, brush or broom. The cervix does not have a lot of pain sensation so this should not hurt, but you can feel it. Once the speculum is removed, your care provider will make sure the uterus and both ovaries feel normal in size and you have no pain in this area. They do this by gently inserting two gloved and lubricated fingers into the vagina and using the other hand to feel these organs by pressing on your lower abdomen. Rectal examinations are not routinely done by most care providers unless there is a problem. Women over age 40 may be more likely to have rectal exams. Be sure to let your care provider know if you have never had a pelvic or rectal exam or if you ever have had problems during an exam.
Your care provider may want to perform other lab tests to make sure you are healthy. Sexually transmitted diseases (STDs) are a big problem in women who have multiple sexual partners and don’t use condoms. Remember, not even condoms will protect you from all infections.
Many times women are not aware that they are infected because they have no symptoms. For this reason, women at any age with a history of risky behavior or evidence of problems, may need special tests. This is easy and painless and involves swabbing the area of the cervix and vagina with a small cotton swab, then waiting a few minutes or days for the results. Non-sexually transmitted diseases such as bacterial vaginosis, and vaginal yeast infections and STDs—trichomniasis, chlamydia and gonorrhea—can be tested in this way. These infections all easily are treated with medications by mouth or vaginal creams, gels or suppositories.
If you are concerned about diseases such as syphilis, genital herpes, HIV or hepatitis, please let your provider know. You easily can be tested for these infections with a blood test. Today, there are very good medications available to control all of these infections. However, the healthiest thing is not to become infected at all.
Since many women see gynecologists and do not have a primary care provider, women’s healthcare providers often will look for signs of other health problems during the well woman exam. This is particularly important in women who have reached midlife and beyond. By screening for symptoms of heart disease and stroke, cancer, diabetes, thyroid, liver and kidney problems, your provider can refer any problems for appropriate follow-up care. With these in mind, some issues your healthcare provider should address include the following:
- The incidence of depression is very high in aging women and something that all care providers should look for.
- Annual mammograms are recommended for all women age 40 and older or earlier for women at greater risk. The combination of monthly breast self exam, annual clinical breast exam by your doctor and a mammogram greatly improves early detection and survival of breast cancer. There have been many recent improvements in mammogram and breast ultrasound. The UT Medical Center Breast Center has all of the latest equipment and expert physicians who deal with breast disease.
- 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. UT Medical Center physicians will schedule this test without requiring an office visit for most women who meet the criteria.
- 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.
- Healthy heart screening is available for women of all ages through the UT Medical Center 4 Your Heart program by calling 865.305.8444. You will be offered an EKG and blood work as well as counseling by a specially trained nurse. All results are reviewed by a cardiologist with referral for any problems that may be detected.
- The well woman exam has identified many healthcare problems of women throughout the life cycle when treatment is possible and cure is optimal. It is an excellent opportunity to seek information on healthy living for you and your family members. Your health is the most precious thing you have.
For the many things that your family depends on you to do, make sure you take care of yourself.