Well Woman Exams

A preventative care visit is recommended annually and may or may not include the following elements in addition to a head to toe women's wellness exam and preventative counseling:

1. PAP (recommended at regular intervals for woman ages 20 to 75)

   Please note that a PAP is not a pelvic exam - it is just one small part of a pelvic exam in which cells from the outside of the cervix are collected to test for precancer. So when you hear us say that PAPs may be recommended every 2 or 3 years instead of every year, that doesn't mean that you shouldn't come in for an annual every year - it just means that the collection of the outside cervical cells may not need to be done every year as part of the pelvic exam.

2. HPV testing is recommended for:
   1. all women over age 30 as a screen
   2. women with a history of an abnormal PAP at any time in the past
   3. women who may have been exposed to an STD
   4. women who have symptoms such as vaginal discharge, genital lesions/warts, cervicitis, post-coital bleeding, irregular bleeding, vaginitis
3. STD testing - Chlamydia and Gonorrhea
   • All women age 25 and under, who are sexually active (please note that this test can be collected off a PAP or from a urine sample), whether or not they have symptoms, every year
   • All women who have never been tested, regardless of age
   • All women who have a new sexual partner since last test, or whose partner might have had a new partner
   • Women who have symptoms such as vaginal discharge, genital lesions/warts, cervicitis, post-coital bleeding, irregular bleeding, vaginitis
4. Other STD testing - HSV (herpes), HIV, Hepatitis, Syphilis

   These STDs are not tested for as routinely as the others are, but are recommended whenever another STD (including HPV) is found. The American College of Obstetricians and Gynecologists now recommends an HIV test every year on every woman as a screen, and most insurances cover for this reason. In addition, the following symptoms are indications for testing: fatigue, nightsweats, fever, skin lesions, among many others.

5. Affirm Testing

   If there is any vaginal discharge that appears slightly unusual or excessive, we generally test it for candidiasis (yeast), gardnerella (overgrowth of potential pathologic bacteria) and trichomonas (parasitic STD).

6. Mammograms

   Currently controversial, there are a few sets of competing recommendations about mammograms. Women's Health Connection follows the American College of Obstetricians and Gynecologists recommendations for mammograms every 1-2 years after age 40 and every year after age 50. Where there is a family history of breast cancer, we start mammograms at those ages, or 10 years before the youngest first degree relative with breast cancer, whichever comes first. A “baseline” mammogram in one's late 30s is no longer recommended - too many false positives.

7. Bone Density

   We believe strongly in prevention and encourage a healthy diet with plenty of protein, vitamin D and calcium, and lots (ie 30 minutes a day, 6 days a week) of weight bearing exercise beginning in one's teenage years or younger, and continuing for a lifetime to prevent osteoporosis in later years. Bone loss begins in one's mid-30s, and takes a rapid decline after menopause. Bone density screening for most women begins around the time of menopause, although may be earlier or later in certain circumstances. May be earlier in the following circumstances:

   • prolonged use of steroids (including inhaled)
   • prolonged use of thyroid medications
   • prolonged use of synthetic progestins such as Depo-Provera
   • prolonged use of anti-seizure medication
   • prolonged use of Depo-Lupron for endometriosis
   • poor calcium intake
   • high caffeine intake
   • unexplained fractures
   • strong family history of osteoporosis
8. Urinalysis
   • all women more than 40 (screen for blood, protein and infection)
   • all women with urinary symptoms
9. Colorectal Cancer Screening

   Colonoscopy recommended every 10 years beginning at age 50 or every 10 years beginning 10 years before the age at which your youngest first degree relative had colon cancer, or more often if you've been diagnosed with colon polyps.

   Every year after age 40 that a colonoscopy is not done, we recommend screening the stool for occult blood which we do at the time of your exam. This is NOT meant to replace a colonoscopy as a screen every 10 years, but is a useful adjunct.

10. Immunizations
    • Gardasil (the HPV vaccine) is recommended for all women up to age 26.
    • A tetanus booster is recommended every 10 years.
    • Hepatitis A and B is recommended for all women under age 25 or those in high risk situations.
11. Skin

    At every annual exam, a skin exam is conducted and we may recommend a shave biopsy for some lesions.

12. Cholesterol Screening

    As a baseline at age 30 (lower in those with risk factors for heart disease, such as obesity, smoking, hypertension, diabetes, family history of high cholesterol or heart disease at a relatively young age).

13. Thyroid Screening

    A good thyroid screen consists of TSH, T3 and T4 and should be done with any symptoms of thyroid disease and every few years as a screen in most women of reproductive age.

14. Other Bloodwork

    It is fairly routine to do a comprehensive metabolic panel, a complete blood count and a vitamin D as screens or with symptoms suggesting an underlying problem. Other labwork depends on your risk factors.

15. EKG and Stress Testing

    EKGs are recommended routinely every year after age 50 as heart disease can be atypical in women. Referral for stress testing with any symptoms that sound like they might be cardiac.

16. Fasting Insulin and Diabetes Testing

    When indicated based on family history or personal symptoms.

17. Contraceptive Counseling +/- Prescriptions
18. Refills of medications for stable problems
19. Identification of Need for Further Management of New or Evolving Problems
    1. Hormonal Problems
    2. Abnormal Bleeding Problems
    3. Bladder Problems (Urgency, Frequency, Leaking)
    4. Prolapse Problems
    5. Sexual Problems
    6. Weight/Metabolic Problems
    7. Gastro-Intestinal/Irritable Bowel Problems
    8. Sleep/Energy/Fatigue Problems
    9. Bone Density Problems
    10. Cholesterol and/or High Blood Pressure Problems
    11. Skin Problems - lesions, acne, sun damage
    12. Problems that Could Benefit from Medical Massage
    13. Nutritional Problems
    14. Fertility Problems
    15. Other gynecologic problems
    16. Other primary care problems
    17. Problems that require a referral out of the clinic.