New Guidleines for Women's Annual Exam

Well, here we go...more changes. Thankfully, Medicine does grow and adapt as new evidence emerges as to how to best care for our patients. Recently (July 2012), the American College of Obstetrics and Gynecologists (ACOG) updated its guidelines for the well women visit.
In brief, here it is:

      At the annual visit, ob.gyns. should counsel women about maintaining a healthy lifestyle and minimizing their         health risks. A physical examination also is key and should include obtaining vital signs, determining body mass index, palpating the abdomen and the inguinal lymph nodes, and assessing overall health.

Pelvic examinations and breast examinations are important at these visits for many, but not for all, women, the Committee on Gynecologic Practice stated.

For example, pelvic exams are recommended annually for all women aged 21 and older, and are "an appropriate component of a comprehensive evaluation" for all women who report symptoms that suggest problems of the genital tract, pelvis, urinary tract, or rectum. Some of these include menstrual disorders, vaginal discharge, infertility, or pelvic pain.

However, pelvic exams are not recommended for women younger than 21 unless indicated by the medical history. "External-only" exams are adequate to assess and discuss with the patient the normal external genital anatomy, issues of person hygiene, and any abnormalities of the vulva, introitus, or perineum that may require further assessment. An external-only exam also gives the ob.gyn. an opportunity to discuss with these young patients the range of normal female anatomy.

For women younger than 21, pelvic exams are not necessary before these women start on oral contraceptives. Pelvic exams also are not necessary for conducting sexually transmitted infection screening for gonorrhea or chlamydia because nucleic acid amplification testing can be done on urine samples or self-collected vaginal swab specimens. This method is also adequate for diagnosing yeast infections, trichomoniasis, and bacterial vaginosis in these young women.

Speculum examination for cervical cancer should commence at age 21, "irrespective of sexual activity of the patient," according to the committee opinion.

There are no data concerning the age at which to begin clinical breast examinations in asymptomatic, low-risk women, but expert opinion suggests that it depends on the woman’s age and risk factors for breast cancer. The committee members recommend breast exams every 1-3 years for women aged 20-39 years and annually for women aged 40 and older.

Soure: ObGynnews.com accessed July 28, 2012