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Essential Elements of Annual Well-Woman Visit Issued

July 23, 2012

Washington, DC -- Although most women no longer need annual Pap tests based on recent cervical cancer screening guidelines, they still need annual well-woman exams with their ob-gyn for other important screenings, evaluations, and immunizations based on their age and individual risk factors. In a new Committee Opinion issued today, The American College of Obstetricians and Gynecologists (The College) details when pelvic exams are needed, which women need clinical breast exams, and why the annual well-woman office visit is so important.

The annual well-woman visit is an excellent opportunity for counseling patients about maintaining a healthy lifestyle and minimizing health risks. A physical exam that assesses overall health generally includes blood pressure, weight, body mass index, palpation of the abdomen and lymph nodes, and an assessment of the patient’s overall health.

A pelvic exam, a common part of the ob-gyn visit, includes three parts: 1) an external inspection; 2) internal speculum exam; and 3) a combination internal/external exam. The College recommends beginning annual pelvic exams at age 21. For younger women, an internal exam is not recommended unless a patient has signs of a menstrual disorder, vaginal discharge, pelvic pain, or other reproductive-related symptom. Screening for sexually transmitted infections (STI), especially in certain age groups, is an important part of the annual exam, but STI testing can now be done using urine samples or vaginal swabs without an internal pelvic exam. Pelvic exams are not necessary before prescribing birth control pills.

The clinical breast exam (CBE) is another important part of the well-woman visit. The College, along with the American Cancer Society and the National Comprehensive Cancer Network, continues to recommend CBEs every one to three years for women ages 20–39. The College recommends annual CBE and annual mammograms for women age 40 and older.

The College notes that decisions on whether to perform internal pelvic exams and/or breast exams should always be made with the patient’s consent.

Committee Opinion #534 “Well-Woman Visit” is published in the August issue of Obstetrics & Gynecology.


Other recommendations issued in this month’s Obstetrics & Gynecology:

Committee Opinion #531 “Improving Medication Safety (Revised)
ABSTRACT: Despite significant national attention, medical errors continue to pervade the US health care system. Medication-related errors consistently rank at the top of all medical errors, which account for thousands of preventable deaths annually in the United States. There are a variety of methods—ranging from broad-based error reduction strategies to the adoption of sophisticated health information technologies—that can assist obstetrician–gynecologists in minimizing the risk of medication errors. Practicing obstetrician–gynecologists should be familiar with these various approaches that, along with efforts directed at assisting the patient in understanding the medical condition for which a medication is prescribed, can improve the safety and efficacy of medication usage.

Committee Opinion #532 “Compounded Bioidentical Menopausal Hormone Therapy (Revised)
ABSTRACT: Although improvement in long-term health is no longer an indication for menopausal hormone therapy, evidence supporting fewer adverse events in younger women, combined with its high overall effective¬≠ness, has reinforced its usefulness for short-term treatment of menopausal symptoms. Menopausal therapy has been provided not only by commercially available products but also by compounding, or creation of an indi¬≠vidualized preparation in response to a health care provider’s prescription to create a medication tailored to the specialized needs of an individual patient. The Women’s Health Initiative findings, coupled with an increase in the direct-to-consumer marketing and media promotion of compounded bioidentical hormonal preparations as safe and effective alternatives to conventional menopausal hormone therapy, have led to a recent increase in the popularity of compounded bioidentical hormones as well as an increase in questions about the use of these preparations. Not only is evidence lacking to support superiority claims of compounded bioidentical hormones over conventional menopausal hormone therapy, but these claims also pose the additional risks of variable purity and potency and lack efficacy and safety data. The College’s Committee on Gynecologic Practice and the Practice Committee of the American Society for Reproductive Medicine provide an overview of the major issues of concern surrounding compounded bioidentical menopausal hormone therapy and provide recommendations for patient counseling.

Committee Opinion #535 “Reproductive Health Care for Incarcerated Women and Adolescent Females (NEW!)
ABSTRACT
: Increasing numbers of women and adolescent females are incarcerated each year in the United States and represent an increasing proportion of inmates in the US correctional system. Incarcerated women and adolescent females often come from disadvantaged environments and have high rates of chronic illness, substance abuse, and undetected health problems. Most of these females are of reproductive age and are at high risk of unintended pregnancy and sexually transmitted infections, including human immunodeficiency virus (HIV). Understanding the needs of incarcerated women and adolescent females can help improve the provision of health care in the correctional system.

The American College of Obstetricians and Gynecologists (The College), a 501(c)(3) organization, is the nation’s leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of approximately 56,000 members, The College strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women’s health care. The American Congress of Obstetricians and Gynecologists (ACOG), a 501(c)(6) organization, is its companion organization. www.acog.org

 

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