A well-woman visit provides an excellent opportunity to counsel patients about maintaining a healthy lifestyle and minimizing health risks. Given the shifting and complex landscape of care, in which many women may not receive all the recommended preventive services, obstetrician–gynecologists have an opportunity to contribute to the overall health and well-being of women throughout the lifespan by providing recommended preventive services and counseling (ACOG).
Results of a study published online in Obstetrics & Gynecology show that the number of women who annually visit an ob/gyn has steadily declined since 2000. Using National Health Interview Survey data from 2000 to 2015, the researchers identified the percentage of US women who visited an ob/gyn and also the percentage of women who visited a primary care physician within the past 12 months.
This study found that more women were provided annual/ preventative care with their GYNs vs primary care physicians (44% had a pap test with their GYNs vs 21% with their PCPs).
Why do we need an “annual” visit?
An annual “preventative” visit provides a unique opportunity for you and your GYN to;
– conduct a thorough history (menstrual, medical, GYN, social and family)
– screen for domestic violence and other high-risk factors
– assess risk factors,
– conduct a physical exam (appropriate for your age and circumstance)
– discuss and advise contraceptive options after mutually shared decision making
– conduct cervical cancer screening tests
– conduct STD tests
– Recommend age-appropriate diagnostics
Before we dig deep into what happens at the annual visit, let’s just get the insurance questions out of the way.
As per the HHS guidelines, all insurance carriers are required to authorize one annual visit (preventative or “free”) visit per year (Medicare only allows an annual GYN visit every 2 years).
What does “free” mean?
This means that you do not need to pay a co-pay, deductible, or co-insurance for a purely annual or preventative visit.
What is included in this “preventative” visit?
As per HHS guidelines, an annual visit only includes the following:
– STD testing
– Cervical cancer preventative screening (not a follow-up if you have been diagnosed with abnormal pap or HPV)
– Contraception discussion and prescription (you may still be responsible for your copays or out-of-pocket costs for the actual birth control pills or IUDs, etc, as per your plan).
– Breast and pelvic exam
– Gestational diabetes risk assessment
Any other symptoms or evaluation are not covered under a “preventative” visit.
You may be asked to come back to discuss other problems at a later date, or your physician may bill you an additional code, and a co-pay or co-insurance will apply.
When should annual visits begin with your GYN?
We get this question all the time at Walk In GYN from many concerned mothers. As per ACOG, the first visit can happen anytime after puberty and/or after the onset of sexual activity.
What happens at an annual visit?
Ah!! Now, this certainly depend on your age. Let’s break it up by age groups. For each age group, we will list out the recommended tests, vaccinations and exams.
Under 21 years age
Symptom evaluation and history taking
– Menstrual problems
Irregular periods are a common reason for adolescents to need a GYN evaluation. With the onset of puberty happening earlier and earlier nowadays, many of you may experience heavy, painful and frequent periods.
On the other hand, many may experience, one normal period and then may skip a couple of months. While such issues are common in adolescence, we at Walk In GYN highly recommend that you seek GYN advice so that you can begin your life’s journey in a safe and health manner.
– STD testing
While many of you may wait till later, there are a lot of you who do initiate sexual activity by this age. It is extremely important that you get routine STI tests to allow early detection and treatment.
Undiagnosed STIs can have severe long term consequences such as pelvic pain, pelvic inflammatory disease and infertility. You only have the power to get tested and treated sooner that later to avoid these long term complications.
– Contraception initiation
We live in a world where women now have a myriad of choices to assist with their reproductive care. This is an extremely important time to have a frank discussion with your GYN (or your pediatrician if your peds is open to discussing that) and initiate a safe and effective form of contraception if you desire. Again, this is a shared decision making process where you can discuss the right fit. We have a ton of resources here at Walk In GYN Care to help you.
– HPV vaccination
If you have not received your HPV vaccine yet, now would be a great time to start the series. In the last 10 years, Walk IN GYN has seen a marked increase in cervical cancer and pre-cancers. Many of these are preventable through HPV vaccination and regular screenings.
HPV vaccination protects against 4 high risk HPV viruses (16. 18, 31, 33) and is now approved for ages 9 through 45 years of age.
Do I need a guardian if I am seeking GYN care?
In the states of NY and CA, minors are allowed to see contraception and STD testing care without the need for a guardian. If you have been emancipated by a court or are deemed capable of making independent decisions (after evaluation by your physician), you can get care without the consent of a legal guardian as well.
Ages 21 to 40 years
This age bracket can be rife with a myriad of issues. Many of you are planning pregnancies or have already had them and are new mothers. You are juggling work, motherhood and simply being you. Life is not easy! We at Walk In GYN are focused on Women’s Empowerment throughout your life’s journey so you can be the best version of yourself from the inside out.
Symptom evaluation and history taking
This would again include a detailed menstrual, GYN, medical, social and surgical history taking.
Assessment of risk factors such as prediabetes, risk of a high risk pregnancy, family history of breast, colon, uterine, pancreatic and thyroid cancers.
A GYN visit also provides a safe space for the evaluation of social factors such as depression, anxiety, and domestic violence.
– STD testing
Testing for STD’s including Gonorrhea/ Chlamydia/ HIV/ Syphilis/ Hepatitis B and C is recommended for all those who are sexually active. Although not universally recommended, we do offer Genital Herpes screening due to the risks of spread and risks to a newborn in case of an undiagnosed and untreated active maternal infection at the time of child birth.
– Contraception discussion
While you may have initiated a form of birth control at a younger age, things start to change in this age bracket. Depending your needs and your risk factors, the options may have to change. You may want to initiate a LARC or may only want a short term contraceptive if you are planning to conceive soon.
– Fertility discussion and preparation
Now would also be a great time to discuss options for fertility preservation and optimizing your body to prepare it for a safe and health pregnancy if that is what you are leaning towards
– Screening
Cervical cancer screening via a PAP test (reflex to HPV under age of 30 years) or PAP (with high risk HPV > 30 yrs age) is recommended. The frequency can be decided through shared decision making. ACOG/ USPSTF and ASCCP recommend spacing out pap and HPV testing to 3 or 5 yrs in low risk population. We at Walk IN GYN (along with most other GYNs) recommend that if you have multiple partners or if your partner has multiple partners or have a history of HPV infection or have any other risk factors affecting your immune status, you should consider more frequent screening. Again, this is a shared decision that you need to make.
Very important: If you choose to defer annual PAP test, you still need an annual GYN visit for all the reasons described above.
Complete physical exam
A thorough physical exam includes a breast, abdominal, skin and pelvic exam (as appropriate). This is a unique opportunity for early diagnoses of many cancers and long term conditions that may otherwise go undetected.
Other diagnostics
– Early mammogram
An early mammogram or breast ultrasound may be initiated at 35 yrs of age if you have a strong family history of breast cancer or are a carrier of the BRCA gene.
Ages 40 yrs to 50 years
In addition to all of the above, we recommend the following age-appropriate diagnostics:
– Mammograms
Mammograms and breast screening starting at age 40 years and then can continue every year or every other year.
– Colonoscopy
Colorectal screening starting at the age of 45 years and continue every 5-10 years as recommended by the gastroenterologist.
– Pelvic Ultrasounds
Pelvic ultrasounds are not a part of the preventative visit but can be conducted at your GYN visit if you have pain, menstrual irregularities, are pregnant or have fibroids and ovarian cysts etc.
– Additional problems that may need attention in this age group can be related to fibroids, pelvic pain, menstrual disturbances, breast pain, vaginal infections and so much more. An annual visit provides you with an opportunity to get these issues evaluated and formulate a treatment plan as indicated.
50 years and above
Hello menopause or perimenopause!
Symptoms of menopause or peri-menopause begin to kick in and now is when you can initiate a discussion on what expect, what to do and how to address these concerns when they begin.
Additional diagnostics
– Thyroid testing:
In addition to all of the above, we also recommend a thyroid evaluation.
– Annual: If not done so already, an annual physical exam with your primary care physician is also important to screen for high BP, cholesterol, cardiac evaluation etc.
– Bone Density
- Bone Density testing is recommended starting at the age of 65 years and every 2-3 years there after,
- Or sooner if high risk factors.
Conclusion
An annual visit provides a unique opportunity for not only preventative screening but also assessment of risk factors, evaluation and treatment initiation of various medical, gynecological and prenatal conditions that may otherwise go undetected.
A team approach with collaboration between your gynecologist, primary care physician, gastroenterologist needs to be utilized as you pass through various age spans. You care team can consist of physicians, nurse practitioners, physician assistants, nurses, sonogram technicians, medical assistants and above all the front desk personnel.
We at Walk IN GYN Care have crafted a unique self-pay Well Woman package that includes a pap/ STD Testing/ Contraception counseling and a pelvic ultrasound. If you don’t have insurance, are traveling or do not want to use your insurance then you can avail yourself of this unique service.
Be safe, be strong and be prepared,
Your friendly Walk In GYN Care team