But regular visits to the gynecologist are an important part of staying well as you age. You may not need obstetrical care, but you still need preventative care and screenings – as well as treatment for a variety of health concerns that can develop over time. Unfortunately, there’s a lot of confusion about different types of exams and screenings, and how often you should get them. Gynecological care involves more than just pelvic exams, and pelvic exams are not the same thing as Pap smears. If you’re confused by what you need and what you should expect in your 40s and beyond, you aren’t alone. Understanding more about basic care, screening guidelines, and expectations can help you make better decisions and get the care you need at any age.
Gynecological exam. A gynecological exam should be an important part of your preventative health and wellness plan as you move from child bearing age into menopause, even if you’ve had a hysterectomy. This is an opportunity for your doctor to assess your overall health, measure your vital statistics, and perform a breast and pelvic exam. But this is also the time to have a conversation with your doctor about the impact of decreased estrogen production on your health and lifestyle, from hot flashes and painful sex to thinning bones and mood swings. Your gynecologist is an expert on the treatment options that are available, and can help you make the right decision for your needs. She or he will also likely you refer you for an annual mammogram, and a colonoscopy if you are over age 50. Depending on your history and whether or not you have a separate primary care physician, she or he may also order routine blood tests or screenings for other issues such as cholesterol, thyroid function, diabetes, and bone density, and refer you to a specialist if necessary.
Pelvic exam. A pelvic exam is generally part of most gynecological visits, and includes an external examination of your genitals, as well as an internal examination of your vagina and pelvic organs. Because the risk of certain types of cancer increases with age, and annual pelvic exam can help identify cysts, fibroids and other early symptoms of cancer when it’s most treatable. It also allows doctors to diagnose infections, including sexually transmitted infections that can occur at any age, and prescribe appropriate treatments. A pelvic exam can also determine the underlying issues causing incontinence or other urinary or bowel concerns that are likely to increase with age. A speculum will be inserted to allow the doctor to examine your vagina and cervix (and take a Pap smear if necessary). Then the doctor will insert two gloved fingers into your vagina while pressing on your abdomen with the other hand to check for growths, tenderness or other causes of pain. It’s important to remember that while any part of a pelvic exam may be uncomfortable, it should not be painful and is generally completed in just a few minutes.
Pap smear. A Pap smear is a screening test that can detect cervical cancer or abnormal cells at the earliest possible stage. The procedure is done during the pelvic exam with a speculum inserted into your vagina, and involves the doctor collecting cells from your cervix (the lower end of your uterus) for testing. This is often combined with a test for human papillomavirus (HPV) -- a sexually transmitted infection that can cause cervical cancer, particularly for women over 40 who likely were sexually active before the HPV vaccination was available.
So how often should you get these important screenings and exams? The American College of Obstetricians and Gynecologists and the women’s health experts at El Camino Hospital recommend a yearly gynecological and pelvic exam to help ensure that any issues or concerns are detected and treated as early as possible. (If you have had a complete hysterectomy, talk to your doctor to see if a pelvic exam is still recommended for you.) Guidelines for Pap smears have changed over the years, and it’s now recommended that women get a Pap smear every three years, or a combined pap/HPV screening every five years during their annual pelvic exam until age 65. Talk to your doctor to be certain you are getting the appropriate exams and screenings every year. It’s your best bet for maintaining your health and wellbeing.
Because your annual gynecological exam is so important, it’s a good idea to take some time to prepare for your visit. Avoid intercourse and douching for two days prior to a Pap smear. Shower as normal, but avoid using any harsh soaps or scented lotions. Take a record of your immunizations, and make a list of any health issues or changes you’ve had in the past year. Everything from a decreased libido and sleep disturbances to weight issues and painful sex will give your doctor a more complete picture of your health as you age, and ensure that you get the personalized and appropriate care you deserve.