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Gynecology

Routine screening recommendations for the annual well-woman exam were recently revised by the American College of Obstetricians and Gynecologists (April 2011). A summary follows:

PERIODIC ASSESSMENT AGES 13-18 YEARS

Obstetrician-gynecologists frequently are asked by adult patients at what age their adolescent daughters should visit an OB/Gyn. The first visit to the OB/Gyn for health guidance, screening and provision of preventive health care services should take place between the ages of 13-15 years. The initial visit at this age serves primarily to establish rapport between the provider and young woman. Generally, it does not include a pelvic exam, although examination of the breasts and external genitals for pubertal development may be appropriate.

1. Screening for menstrual status, nutrition assessment, tobacco, alcohol and drug use, abuse/neglect and sexual practices

2. Physical examination to include height, weight, body mass index, blood pressure, Tanner staging/secondary sexual characteristics, pelvic exam (only if indicated by medical history)

3. Laboratory Testing to include chlamydia and gonorrhea testing if sexually active, HIV testing if sexually active

4. Evaluation and Counseling for sexuality including high risk behaviors, preventing pregnancy, contraception and sexually transmitted disorders; psychosocial evaluation including suicide/depressive symptoms, sexual orientation and gender identity, family and school relationships, personal goal development

PERIODIC ASSESSMENT AGES 19-39 YEARS

1. Screening for menstrual status, nutrition, tobacco, alcohol and drug use, abuse/neglect, sexual practices, urinary and fecal incontinence

2. Physical examination to include height, weight, body mass index, blood pressure, pelvic exam


3. Lab Testing to include cervical cytology starting at age 21, chlamydia and gonorrhea testing under 25 years of age

4. Evaluation and Counseling to include contraceptive options, reproductive health plan, preconception counseling; psychosocial evaluation to include interpersonal relationships, intimate partner violence, stress and sleep disorders

PERIODIC ASSESSMENT AGES 40-64 YEARS


1. Screening for use of complementary and alternative medicine, pelvic prolapsed, menopausal symptoms, urinary and fecal incontinence

2. Laboratory Testing to include cervical cytology, colorectal cancer screening starting at age 50, fasting glucose test every 3 years after 45 years, lipid profile assessment every 5 years beginning at age 45, mammogram every 1-2 years beginning at age 40, yearly at age 50, thyroid stimulating hormone every 5 years beginning at age 50.


3. Evaluation and counseling for family relationships, intimate partner violence, work satisfaction, retirement planning, stress and sleep disorders

PERIODIC ASSESSMENT AGES 65 YEARS AND OLDER

1. Screening for pelvic prolapsed, menopausal symptoms, urinary and fecal incontinence

2. Laboratory Testing to include bone mineral density screening not more frequently than every 2 years, cervical cytology, colorectal cancer screening every 10 years by colonoscopy, lipid profile every 5 years, thyroid stimulating hormone every 5 years, annual mammogram, fasting glucose level every 3 years.


3. Evaluation and Counseling to include transmission of STDs, partner selection and barrier protection, calcium intake, work/retirement satisfaction

For more information go to www.acog.org

 

Breast Health

Self breast examination should begin by the age of 20 according to the American College of Obstetricians and Gynecologists and the American Cancer Society. It should be performed on a monthly basis and the best time is a few days after your period ends. Talk to your doctor about how to perform a self breast exam. For more information, go to www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-detection

Mammograms should begin at the age of 40 every 1-2 years and then annually at the age of 50 according to the American Cancer Society. Screening mammography is not a perfect exam, but is the best tool available to detect cancer early, which can lead to better options and possibly less aggressive treatments. If you are concerned about when to begin screening mammograms, talk to your doctor and learn what is right for you based on your individual risks. It is important that the doctor and patient work together to develop a screening plan.

 

Resources:

Main Line Health

Paoli Hospital

ACOG

HPV