A well-woman exam is an annual preventive screening of breast and gynecological diseases. It is recommended that annual visits to an obstetrician/gynecologist begin at age 21, or earlier, if a woman is sexually active.

During the visit, your ob/gyn will discuss your health and lifestyle behaviors and will perform a physical exam. The doctor will ask about your menstrual cycle, your exercise and eating habits, smoking and alcohol consumption, and sexual activity.

Your doctor will conduct the following exams during the well-woman exam:

• Breast exam – depending on age and medical history, a mammogram may be ordered.
• Pelvic exam – depending on age, a Pap smear and possibly a test for the human papilloma virus (HPV) may be performed.
• Bone density scan – depending on age and medical history, this may be ordered.

A Pap test, or Pap smear, checks the cervix for abnormal cell changes. The cervix is the lower part of the uterus (womb), which opens into the vagina. Cell changes can develop on the cervix that, if not found and treated, can lead to cervical cancer. Cervical cancer can almost always be prevented, and having regular Pap tests is the key.

Your doctor can do a Pap test during a pelvic exam. It is a simple and quick test in which s/he will use a swab to take a few cells from the surface and inside of the cervix. The cells are placed on a glass slide and sent to a lab for testing.

During a clinical breast exam, your ob/gyn checks the appearance of your breasts. You may be asked to raise your arms over your head, let them hang by your sides, or press your hands against your hips. These postures allow your healthcare provider to look for differences in size or shape between your breasts. The skin covering your breasts is checked for any rash, dimpling, or other abnormal signs. Your nipples may be checked to see if fluid is expressed when lightly squeezed.

Using the pads of the fingers, your ob/gyn checks your entire breast, underarm and collarbone area for any lumps or abnormalities. The manual exam is done on one side and then the other. Your healthcare provider will also check the lymph nodes near the breast to see if they are enlarged.

If you are sexually active, getting tested for STDs is one of the most important things you can do to protect your health. Make sure you have an open and honest conversation about your sexual history and STD testing with your doctor and ask whether you should be tested for STDs.

Below is a brief overview of STD testing recommendations from the Centers for Disease Control and Prevention. All adults and adolescents from ages 13 to 64 should be tested at least once for HIV.

• Annual chlamydia screening of all sexually active women younger than 25 years, as well as older women with risk factors such as new or multiple sex partners, or a sex partner who has a sexually transmitted infection.
• Annual gonorrhea screening for all sexually active women younger than 25 years, as well as older women with risk factors such as new or multiple sex partners, or a sex partner who has a sexually transmitted infection.
• Syphilis, HIV, chlamydia, and hepatitis B screening for all pregnant women, and gonorrhea screening for at-risk pregnant women starting early in pregnancy, with repeat testing as needed, to protect the health of mothers and their infants.
• Women who have sex with women (WSW) should not assume to be at low or no risk for STDs, based on sexual orientation. Recent studies indicate that some WSW, particularly adolescents, young women, and women with both male and female partners, might be at increased risk for STDs as a result of certain behaviors and practices that allow for transmission of infected cervicovaginal secretions. These can include trichomoniasis, BV (bacterial vaginosis), and HIV, as well as HPV, which can be transmitted through skin-to-skin or skin-to-mucosa contact.
• Women who have unsafe sex or share injection drug equipment should get tested for HIV at least once a year.

The type of treatment a woman is given after receiving abnormal Pap smear results will depend on what caused the abnormal test results.

Infection: If your abnormal test results were caused by a vaginal infection or a sexually transmitted infection, you can be treated with medicine.

Menopause: Women near menopause may have abnormal results because of normal body changes during menopause. These minor cell changes may improve with the use of estrogen cream.

Moderate or severe cell changes: Your treatment will focus on destroying or removing the abnormal tissue. Treatment choices include cone biopsy, loop electrosurgical excision procedure (LEEP), cryotherapy and laser therapy.

Cervical cancer: Treatment will focus on destroying or removing the cancer.

Endometrial biopsy is the removal of a small piece of tissue from the lining of the uterus (endometrium) for examination.

An endometrial biopsy is performed to determine the cause of abnormal menstrual periods (heavy, prolonged, or irregular bleeding), bleeding after menopause and other abnormal bleeding, to evaluate thickened uterine lining seen on an ultrasound, and to determine the presence of endometrial cancer.

Urodynamic testing is any procedure that looks at how well the bladder, sphincters, and urethra are storing and releasing urine. Most urodynamic tests focus on the bladder’s ability to hold urine and empty steadily and completely. Urodynamic tests can also show whether the bladder is having involuntary contractions that cause urine leakage. A health care provider may recommend urodynamic tests if symptoms suggest problems with the lower urinary tract. Lower urinary tract symptoms include:

• urine leakage
• frequent urination
• painful urination
• sudden, strong urges to urinate
• problems starting a urine stream
• problems emptying the bladder completely
• recurrent urinary tract infections

Your doctor can give you more detailed information about why and how urodynamic tests are conducted.

Menopause is the time of life when a woman's ovaries stop producing hormones and menstrual periods stop. Natural menopause usually occurs around age 50. A woman is said to be in menopause when she hasn't had a period for 12 months in a row.

Your ob/gyn can help you manage menopausal symptoms and monitor your risk for bone density loss and cardiovascular disease, both of which increase during the postmenopausal years.

Human papillomaviruses (HPVs) are a group of more than 200 related viruses. More than 40 HPV types can be easily spread through direct sexual contact, from the skin and mucous membranes of infected people to the skin and mucous membranes of their partners. They can be spread by vaginal, anal, and oral sex.

HPV infects at least 50% of sexually active people at some point in their lives. The virus often clears from the body on its own. However, if it persists, it can lead to cervical, anal and throat cancers, and to genital warts.

HPV vaccines protect against certain types of HPV. The Food and Drug Administration has approved three vaccines to prevent HPV infection: Gardasil®, Gardasil® 9, and Cervarix®. The vaccine is administered in a series of three shots. These vaccines provide strong protection against new infections by certain types of high-risk HPV viruses, but they do not treat existing HPV infections or disease caused by HPV.

The Advisory Committee on Immunization Practices has developed the following recommendations regarding HPV vaccination of adolescent and young adult females and males:

• Initiation of routine HPV vaccination at age 11 or 12 years (the vaccination series can be started beginning at age 9 years)
• Vaccination of females aged 13 through 26 years and of males aged 13 through 21 years who have not been vaccinated previously or who have not completed the three-dose vaccination series.

Your doctor (ob/gyn or pediatrician) can provide further guidance as to when girls and young women should be vaccinated, as well as which vaccine to take.