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:
3. STD testing - Chlamydia and Gonorrhea
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.
Currently controversial, there are a few sets of competing recommendations about mammograms. 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, mammograms may be started 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.
6. 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 testing for most women begins around the time of menopause, although it may be recommended earlier or later in certain circumstances, and is often ordered for diagnostic rather than preventative reasons in certain circumstances. May be earlier in the following circumstances:
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.
At every annual exam, a skin exam is conducted and we may recommend a shave biopsy for some lesions.
11. 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).
12. Thyroid Screening
Thyroid screening should be done with any symptoms of thyroid disease and every few years as a screen in most women of reproductive age.
13. Other Bloodwork
As recommended by the USPSTF guidelines.
14. 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.
15. Fasting Insulin and Diabetes Testing
When indicated based on family history or personal symptoms.
16. Contraceptive Counseling
17. Identification of Need for Further Management of New or Evolving Problems
Abnormal Bleeding Problems
Bladder Problems (Urgency, Frequency, Leaking)
Debra Ravasia, updated 2017