Well Women Examination

The Well Woman Exam is performed in 5 stages:

• Health History

If you are establishing care with a new healthcare professional, your first visit may be longer and more involved than later office visits. Since your care provider is not familiar with you, a detailed medical, family, obstetric, gynecologic, genetic and psychosocial history is done to develop a complete plan of care. This is called the health history. It is important to know your family medical and genetic history, if possible. Some questions you will need to answer include:
• Have you ever been pregnant and, if so, did you have any problems?
• Are you planning a pregnancy?
• Are you experiencing any health problems now?
• Are you up-to-date on shots?
• What about eating habits and exercise?
• Are you smoking?
It always is a good idea to bring any medical records and a list of medications that you may already be taking to your first health visit. Remember to include any use of alternative treatments such as herbal preparations or acupuncture.
The well woman exam is a good opportunity to discuss any concerns that you may not feel comfortable talking about with friends or family such as infection, drug and alcohol use, depression and domestic violence. Any health information you reveal is kept confidential, by law, so be sure to ask your care provider about any concerns. It always is a good idea to write down any questions you have and bring your list with you. Remember, no question is stupid. Your care provider wants to make sure you receive a complete plan of care in order to help you be healthy in every way

• Physical Exam

The physical exam is a head-to-toe exam that gives clues to any health problems. Blood pressure, weight, urine testing and a check for anemia often are done. Your care provider likely will examine eyes, ears, nose, mouth, thyroid gland, lungs, lymph nodes, heart, breasts, abdomen, reflexes, skin and bone and spine. Any problems that are noted may need referral to another care provider. Eye and dental care is a must for overall health, too, and you should seek routine care for these health issues.

• Breast Exam

This exam, performed by your provider, is a very important part of the yearly well woman exam. It should be done for women of all ages to look for any evidence of breast disease. A good exam starts by sitting up with arms above the head for any signs of an abnormal look to the breast such as dimpling, nipple inversion (where the nipple turns in, not out), an orange peel appearance or any redness, soreness, rash or swelling. Your provider will touch each breast with the pads of the three middle fingers for evidence of lumps or thickening from the bottom of the breast to the collar bone and up under each arm pit. This area is all breast tissue and needs to be checked.
When, you lie down, the exam is performed again, looking for the same abnormal findings. Nipple discharge is important to access and a gentle squeeze on each nipple is done for this purpose. Even though you may have a negative clinical breast exam, you should continue monthly breast self-exams, performed the same way, in order to give yourself the best protection against breast cancer.

• Pelvic exam and an assessment for other health problems

The pelvic exam specifically determines if the outer sexual parts (vulva and labia) and the inner organs (vagina, cervix, uterus and ovaries) are healthy. To do this, your care provider will look at the outer area for any problems then gently insert a sterile instrument called a speculum into the vagina, in order to see the entire vagina and the lower part of the uterus called the cervix. This allows your care provider to observe any abnormal discharge or appearance to the vagina and cervix. Try to relax. You should feel some pressure but no pain. An annual pap smear to detect abnormal cell changes of the cervix that could lead to cancer may be done at this time. This involves scraping the outer and inner area of the cervix with a small instrument called a palate, brush or broom. The cervix does not have a lot of pain sensation so this should not hurt, but you can feel it. Once the speculum is removed, your care provider will make sure the uterus and both ovaries feel normal in size and you have no pain in this area. They do this by gently inserting two gloved and lubricated fingers into the vagina and using the other hand to feel these organs by pressing on your lower abdomen. Rectal examinations are not routinely done by most care providers unless there is a problem. Women over age 40 may be more likely to have rectal exams. Be sure to let your care provider know if you have never had a pelvic or rectal exam or if you ever have had problems during an exam.

• Lab Tests

Your care provider may want to perform other lab tests to make sure you are healthy. Sexually transmitted diseases (Stds) are a big problem in women who have multiple sexual partners and don’t use condoms. Remember, not even condoms will protect you from all infections. Many times women are not aware that they are infected because they have no symptoms. For this reason, women at any age with a history of risky behavior or evidence of problems, may need special tests. This is easy and painless and involves swabbing the area of the cervix and vagina with a small cotton swab, then waiting a few minutes or days for the results. Non-sexually transmitted diseases such as bacterial vaginosis, and vaginal yeast infections and Stds—trichomniasis, chlamydia and gonorrhea—can be tested in this way. These infections all easily are treated with medications by mouth or vaginal creams, gels or suppositories. If you are concerned about diseases such as syphilis, herpes, HIV or hepatitis, please let your provider know. You easily can be tested for these infections with a blood test. Today, there are very good medications available to control all of these infections. However, the healthiest thing is not to become infected at all.