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Guidelines for Well-Woman Gynecologic Visits

Guideline Watch |
August 23, 2012

Guidelines for Well-Woman Gynecologic Visits

  1. Diane E. Judge, APN/CNP

The ACOG recommendations emphasize the value of annual visits and encourage shared decision making.

  1. Diane E. Judge, APN/CNP

Annual well-woman gynecologic health assessments can promote prevention, identify disease risk and existing medical problems, and establish clinician–patient relationships, according to new expert-opinion–based guidelines from the American College of Obstetricians and Gynecologists (ACOG). Major recommendations include:

  • The first gynecologic visit should occur between age 13 and 15 and should emphasize education (e.g., body image, weight management, immunizations).

  • Pelvic examination is not a prerequisite to testing for sexually transmitted diseases or to initiating oral contraceptives in healthy, asymptomatic women.

  • Annual examination of the external genitalia should be performed in all women; complete pelvic examination is recommended for all women aged ≥21. Despite lack of evidence about the value of internal examinations, decisions about performing such examinations should be made jointly by clinician and patient “after shared communication and decision making.”

  • Annual pelvic examination is not necessarily required in healthy, asymptomatic women who have undergone total hysterectomy and bilateral salpingo–oophorectomy for benign indications and who have no histories of genital tract neoplasia, or in women who, because of age or health status, would choose not to act should abnormalities be discovered.

  • Clinical breast examination is recommended, although clear evidence of benefits or harms is lacking.

Comment

Many clinicians have feared that extending Pap smear intervals to or beyond 2 to 3 years would result in missed opportunities for preventive care (JW Womens Health Apr 12 2012). The ACOG committee addresses this concern by explaining the benefits of annual visits beyond cervical cancer screening. The Affordable Care Act mandates insurance coverage of yearly well-woman visits, thereby facilitating insured women's access to these services. Many women believe the terms “Pap smear” and “pelvic exam” are synonymous. For shared decision making to be meaningful, we must continue educating women that the need for a Pap smear is not the only reason to seek well-woman care.

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