Women's Health Today

Caring and listening to the needs of women

What to Expect at your Well Woman Exam

Jeanne Faulkner 2/2008

It's on every woman's list of things they don't want to do: Clean the bathroom, balance the checkbook, dump the kitty-litter, schedule annual exam. And yet, you'd better put it on the top of your list. You can live with a dirty bathroom and litter box and sure, the checkbook's important but not as important as your health. Letting your annual exam slide is a potentially dangerous thing to do. For those of us who've been around the block, we know this exam is really no big deal. It's not painful or terminally embarrassing. It's just a fact of life. For those who've never had a complete well-woman exam, you're probably worried about what to expect. It's far easier than you think and the reassurance you'll feel when it's checked off your list makes it totally worth it.

How to prepare:

We'll send paperwork before your appointment. Try to get it all filled out before you come in. Be sure to schedule enough time for your appointment. We'll do our best to see you promptly, but at times our doctors have to run out and deliver babies and get a little behind. We know your time is important and we'll do our best to respect that.

Bring a list of all your medications and questions. Remember this is an exam to focus on routine health issues, if an urgent, specific gynecological issue is occurring we may choose to focus on that and save the woman’s health exam for another day. We may schedule a follow up appointment for you to discuss a specific problem in more detail at a later time.

What to expect:

A well woman’s exam includes a review of your health history and a brief physical exam, including a careful breast exam and pelvic exam. Liana Corliss, FNP states, “The focus of the well woman’s exam is routine health screening, health promotion and early detection of disease. We will review and recommend screening guidelines according to a woman’s specific needs and her stage of life.”

  1. Height and Weight– Yeah, we know, we hate stepping on the scale too, but consider it your reality check. We all fluctuate a little and even shrink a bit, but if there's a big difference from previous exams, it's a heads up. We may need to talk about how your diet and exercise habits are affecting your total health. We may need to look at bone density and rule out osteoporosis. No worries, ladies and no judgments either. We understand and struggle with these issues ourselves.
  2. Vital signs: We'll check blood pressure, pulse and listen to your heart and lungs. If we find any areas of concern, we'll either refer you back to your family physician for follow-up or hook you up with a specialist.
  3. Health History: We start our exam by talking. We'll discuss your health history, questions and concerns.
  4. Thyroid exam: We'll feel an area on your throat for your thyroid gland. An enlarged or lumpy thyroid may be a sign of hypothyroidism or hyperthyroidism. Both can affect metabolism, energy levels, weight, fertility and menstruation. If we suspect a problem, we'll follow up with a blood test and/or a referral to an endocrinologist or your family physician.
  5. Breast Exam: We'll examine the breasts in two positions – sitting and lying down. We'll look for any irregularities in the skin, discolorations, puckering, lumps, lesions or nipple discharge. Then we'll feel the whole breast and up into the armpit in an up and down vertical motion. If we feel anything unusual or different from previous exams, we'll rule out trouble with diagnostic exams.
  6. Abdominal Exam: a thorough poke in the belly. We're feeling for your liver, stomach, spleen, intestines, and uterus.
  7. Pelvic Exam: We examine your pelvis in two ways: With a speculum and our fingers (a bimanual exam).
    • Speculum exam: A speculum is a duck-bill shaped, metal instrument that slides into the vagina and opens up to allow us to visualize the vagina and cervix. You'll lie on your back, place your feet in the stirrups (medical-speak for "a place to stick your feet"), and scoot your butt down to the end of the exam table (don't worry, no one's ever fallen off). Now, here's the hard part: open your knees. We'll keep you covered with a drape and do our best to be quick about it. Let us know if this is particularly frightening or difficult. We're here to help – really, we are.

      Next step, we carefully slide the speculum into your vagina and open it in order to visualize the vagina and cervix. Once it's opened, we'll shine a light and look at the vaginal tissues. We're checking for color of the skin, appearance of the cervix (opening of the uterus) and for any unusual lumps, lesions or discharge. This is when we'll do a Pap smear (see below), vaginal cultures or testing for sexually transmitted diseases if indicated. We'll slide the speculum out and move on to the bimanual exam.

    • Bimanual Exam: That's fancy talk for a two-handed exam. We'll put a little lubricant on the gloved fingers of one hand and slide them into the vagina. We'll locate the cervix, uterus and ovaries and gently press up while we press down on your abdomen with our other hand. We'll check the size and location of your uterus and ovaries and give a good feel for anything unusual or painful. The whole thing usually takes less than a minute.
  8. Rectal Exam – don't worry, we don't have to do this regularly on most women until they're past 50. It's quick and painless. One finger, a couple of seconds, all done. We’ll also check if there is any evidence of blood in the stool sample, which can be an early warning sign of colon cancer.
  9. Pap Smear/ HPV Screen: Death from cervical cancer is going down, partly due to women getting regular Pap smears. The Pap's been updated. We use a liquid-based Pap which allows screening for high risk human papilloma virus types - the primary cause of cervical cancer.

    The Pap smear examines cells that line the opening to the cervix. How do we do that? We gently scrape cells off the cervix during the speculum exam and send it of to a lab. They'll get back to us with results within a week or so and we'll let you know if anything is abnormal.

    We recommend a yearly well woman’s exam for all women. However, we tailor the timing of the Pap Smear/ HPV screen to each woman. For young women and adolescents, we recommend getting your first Pap three years after onset of sexual activity or by age 21. However a woman should come in at the onset of sexual activity or ideally before to discuss issues such as family planning and sexually transmitted disease prevention and screening. Monogamous women who've had three consecutive normal Paps and no evidence of high risk HPV may not need them annually. Every two to three years may be enough. For women who've had a previous abnormal pap, your provider will let you know of the appropriate follow-up schedule.

There will also be time to discuss your individual concerns regarding women’s health care. We'll talk about your contraception, sex life, menopause issues – whatever's important to you. Liana Corliss, FNP states “Women’s health care guidelines are often in flux and are based on the medical evidence available. We are here to interpret them and provide the information you need to make decisions about your health care. We are in a partnership with our patients and are here to listen as well as provide information.”

So pick up the phone ladies and cross "schedule annual exam" off your list. Now that you know what to expect, it’s not that scary anymore, right?