Getty Images Most of us associate going to the ob-gyn with getting birth control refills or pregnancy checkups. But as you head through your 30s, 40s and beyond, you're looking at a whole new spate of needs. Maybe you're curious about your fertility status or, on the flip side, a more permanent birth control option. You might be wondering about shifts in your period caused by changing hormone levels, or about how often you need mammograms and Pap smears. Yes, the age-old advice to see a gynecologist at least once a year for a checkup and pelvic exam generally still holds true. Unfortunately, recent controversies about when women should get cancer screenings and other tests have made it less clear what the gold standard is for that yearly exam. With the help of top medical experts, we put together a checklist that ensures you're getting the best, most up-to-date care.
A good gyno exam…May Not Include a Pap Smear
Pap smears—which detect abnormal, potentially cancerous cells on your cervix—were once recommended yearly for any woman older than 18. Then research began to pile up showing that cervical cancer, which is usually caused by a human papillomavirus (HPV) infection, tends to be slow-growing, often taking years to develop. What's more, most abnormal Pap results and HPV infections (diagnosed via a separate test) clear up on their own within a few months. So once-a-year screenings may be overkill for many women, especially because they expose us to unnecessary follow-up tests, painful procedures and anxiety.
Related: 17 Things You Should Know About HPV
Fast-forward to today: The latest guidelines from the American Congress of Obstetricians and Gynecologists (ACOG) and the American Cancer Society (ACS) say that most women younger than 21 don't need Paps at all, women age 21 to 30 should get them every three years and women older than 30 can stretch it to every five if they get an HPV test, too, assuming all results are negative. (Like Pap smears, HPV tests are conducted on a swab of cells taken from your cervix. Your ob-gyn can take both samples at the same time.) In fact, in March, an FDA advisory committee recommended allowing one brand of HPV test to be marketed as a first-line screening for cervical cancer. (Most gynos automatically test for HPV in women older than 30, but check with your doctor to be sure that she's doing it.)
That said, some providers still believe that getting screened once a year is best. "Many women want to have Pap smears more often, and most of my colleagues will perform them more frequently," says Adelaide Nardone, MD, an ob-gyn based in New York City.
Mary Jane Minkin, MD, clinical professor of obstetrics, gynecology and reproductive sciences at Yale University, falls in that camp. "While there's no question that screening every three to five years is fine," she says, "I've diagnosed two ovarian cancers and a uterine cancer on Pap smears when ovarian and uterine cells ended up on the cervix. If I hadn't been checking women as often, I might have missed those." Bottom line: You may want to ask your doctor to screen every year or two instead.
A good gyno exam…Is Given by a True Specialist
That may sound obvious, but not every woman goes to an ob-gyn for her reproductive care. If you're just getting a yeast infection treated, say, then it's fine to see a family-practice MD, nurse practitioner or nurse-midwife, Dr. Nardone says. But, she adds, if things are less straightforward—e.g., you have an abnormal Pap result or are approaching perimenopause and need to talk about hormones—seek out an ob-gyn, who has had specialized training in these areas.
Another option: If you're not getting pregnant again (or ever), consider switching to a gynecologist who doesn't practice obstetrics. "She's not going to be out of the office delivering babies and will focus on purely gynecologic issues," says Nieca Goldberg, MD, director of the Joan H. Tisch Center for Women's Health at NYU Langone Medical Center. The main benefit is time saved in the waiting room. Love your current ob-gyn and don't mind reading a few extra magazines before you're seen? Stick with her!
Next Page: A good gyno exam…Means Taking Off Your Bra [ pagebreak ]
gyno-doc screening guidelines keep evolving, but one step most medical organizations—and our experts—agree on is a yearly in-office exam. How your doctor should do it, according to the ACS: While you're undressed from the waist up, your doc will examine your breasts for any abnormalities, gently pressing the skin and nipples, as well as under both arms, to feel for possible lumps.
As for mammograms, different groups have different guidelines about when to get them. The United States Preventive Services Task Force recommends screening every two years starting at age 50, based on evidence that beginning earlier could subject women to invasive, harmful treatments that may turn out to be unnecessary. On the other hand, the ACOG, ACS and American Medical Association still suggest yearly mammograms for women 40 and up. So you and your ob-gyn should discuss your own plan yearly, based on personal factors like your family history of breast and ovarian cancers.
Note: If your doctor hasn't discussed mammograms with you yet and you're 35 or older, bring them up yourself—some women with a family history of early cancer should start in their 30s.
A good gyno exam…Doesn't Leave You Hanging
Ever go in for a test and then never hear another word about it? Chances are, your doctor has a "No news is good news" policy and calls patients only when the results are concerning, says David Plourd, MD, an ob-gyn at Scripps Memorial Hospital in Encinitas, Calif. But that's not ideal, because a doctor could get bad news that somehow falls through the cracks. "Ask him, 'Should I call you for results, or will you call me?'" Dr. Plourd suggests.
Same goes for knowing when to come back. It may seem like a trivial matter, but skipping screenings and follow-ups could mean missing something serious. So if your doctor's office doesn't follow through, look for a practitioner who's more on the ball. Your life could depend on it.