What Women Need In A Checkup: Test Less, Talk More
Healthy young women can be forgiven for being confused about how often they're supposed to be getting in to see their primary care doctor.
After all, annual checkups in general have come under scrutiny. Doctors who have reviewed the data say there is little scientific evidence to support routine pelvic exams or clinical breast exams in women who have no symptoms. Cervical cancer screening is now recommended only every three years. Even a routine blood test to measure cholesterol levels isn't recommended for women under 45.
So, is it best to skip that annual wellness visit with a gynecologist or other family practitioner?
Not necessarily. For one, there may be tests you aren't aware you should be getting. The U.S. Preventive Services Task Force recommends screening for chlamydia and gonorrhea in sexually active women 24 and younger, and in women older than that if they are "at increased risk for infection." And it recommends screening everyone ages 15 to 65 for HIV. It's not clear how often those tests should be done, but the task force says a "reasonable" approach would be a one-time screening, with further tests for people who engage in unprotected sex with a new partner, or develop other risk factors.
And even if you don't need a physical exam, it's good to schedule periodic face-to-face discussion with your doctor about preventive care or other health concerns, says Dr. Jennifer Gunter, a San Francisco Bay Area OB-GYN and pain specialist. Recommended routine care includes screening for problems like alcohol misuse, depression, obesity and intimate partner violence.
"It's about the conversations," says Dr. Wanda Filer, a family physician and president of the American Academy of Family Physicians. "What I like to say is, if there's something you want to talk to me about, it's fair game."
Women often save up questions for an annual office visit that they think don't warrant a sick visit to the doctor during the year, says Dr. Barbara Levy, an OB-GYN and vice president of health policy for the American College of Obstetricians and Gynecologists. That could mean asking whether the irregularities of your period are normal, or why you're tired all the time, or what Zika means for your plans to conceive. Or maybe you're wondering whether the method of birth control you've been using is the right one for you, or why you're experiencing incontinence when you sneeze, or whether you should start mammograms in your 40s, at 50 — or earlier — if you have a family history of the disease.
Some of those concerns might prompt a physical exam or test, but others won't.
Lots of women have questions for a doctor about their sex lives, says Gunter. Sex and some other topics are easier to discuss with a practitioner you know. "If you want to ask why you're having trouble orgasming, are you going to ask someone you've never met before?" says Gunter.
In some cases, that sort of check-in could even be done over the phone, she says.
Filer says patients shouldn't feel guilty about skipping an annual visit if they're up to date on recommended preventive care, including adult immunizations. But those who do like to touch base every year shouldn't feel guilty about scheduling an office visit, or worry they're wasting the doctor's time, she says. If your primary aim is to chat, just say that up front.
"You can say 'I don't think I need any tests, but please tell me if that's not true — I just want to be sure I have a relationship with a doctor,' " Filer advises. "Most family medicine doctors would value that immensely."
Katherine Hobson is a freelance health and science writer based in Brooklyn, N.Y. She's on Twitter:@katherinehobson
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