When the Pap smear guidelines changed several years ago, shifting the recommendation that patients be screened for cervical cancer [1] once a year to every three to five, I immediately started getting questions from patients about how often they needed to come back and see me: "My internist told me I only need to come in every three years or so. Is that true?" While those guidelines often do apply, a Pap smear isn't the only reason to see your gynecologist [2]. Here's what you can expect from an appointment and why it's important to add it to your calendar at least once a year.
1. Your Doctor Will Check Your Vital Signs
Your vitals signs include your height, weight, blood pressure, and sometimes your temperature. Hypertension is known as a silent killer — because while it may not cause any symptoms, even slightly elevated blood pressures can increase your risk of heart disease — and yet most people never have their blood pressure checked outside of a doctor's office. This makes taking vitals during your annual exam essential. While you should have a primary care physician, too, I know I'm the only doctor some patients see regularly.
2. You'll Be Screened For STIs
Much like high blood pressure, sexually transmitted infections may not cause any symptoms [3]. In fact, that's why they're called STIs; while there's a bacteria or virus present in the body, a doctor wouldn't yet refer to it as a sexually transmitted disease because, by definition, diseases manifest certain signs and symptoms. Using condoms can help reduce the spread of STIs, but it doesn't eliminate your risk completely, so you should get tested [4]. According to the Centres For Disease Control, the spread of chlamydia, gonorrhea, and syphilis is at an all-time high [5].
3. Your Doctor Will Still Take a Look Around
Under the current guidelines, it's acceptable to go three to five years between Pap tests, depending on your age and medical history. A Pap smear screens for cervical cancer by collecting microscopic cells from the cervix, but during an exam, your gynecologist also feels your breasts and pelvic organs — including your cervix, uterus, and ovaries — for any abnormalities, like masses or fibroids. I've even spotted countless thyroid masses during routine exams that the patient hadn't yet recognised.
4. You'll Discuss Your Periods and Birth Control
It's easy to experience gradual changes in your menstrual cycle and not know if they've breached the limits of normal. That's why I ask patients a string of questions about their periods during an annual exam: are they regular? Crampy? Do you ever mess up your clothes or sheets? Those answers can help me determine if a person is bleeding too much [7] and needs to be evaluated for anemia and causes of heavy bleeding. In some cases, even light periods can be a concern [8].
Likewise, how you're feeling on your birth control [9] can change, and that's an important conversation to have with your doctor. If you're using a hormonal method, your gynecologist also needs to check your blood pressure and weight periodically — in addition to assessing any family history of blood clots or certain forms of cancer — to ensure it's safe for you to continue using it. Even if you're only using a barrier method, your doctor can help you determine if it's working effectively enough on its own or if you should add another method to better protect against pregnancy.
So, how often should you see your gynecologist? Every year, and more often if there are any problems or concerns, or if you change sexual partners. Remember, your gynecologist should be the last person to judge your reason for coming in. Don't be embarrassed. We've seen and heard it all and only want to help you to be as safe and healthy as you can be.