What a well-woman exam is and why it is important

One of the most important things we can do to manage and maintain good physical health is to keep up on all of those routine checkups. This means going to the dentist regularly for cleanings, getting yearly skin checks at your dermatologist’s office, seeing your primary care physician for your annual physical and, for women, getting a well-woman exam each and every year. 

What is a well-woman exam?

While a standard physical exam is more focused on overall health, a well-woman exam (also called a gynecological exam) is designed to zero in on health issues that are specific to the female reproductive health. The exam can be conducted by a primary care provider, an obstetrician-gynecologist , a women’s health nurse practitioner, a physician’s assistant, or a certified nurse midwife (a CNM is a registered nurse who has obtained graduate-level certification in midwifery; they frequently work in clinics alongside OB-GYNs). 

Whichever practitioner you choose to see for your well-woman exam, it is important to make sure they are up to date on screening guidelines and recommendations, because these change as new research comes out, says Lexi Garbus, a CNM in a private practice in Detroit. 

What happens at a well-woman exam?

At your well-woman visit, you will likely receive a clinical breast exam, a pelvic exam, and/or a Pap smear, all of which are designed to help spot abnormalities that require further investigation (Pap smears, for example, detect cervical cancer). Your provider will also want to discuss the length and frequency of your periods, your sexual and reproductive history, as well as whether you are experiencing any unusual symptoms, such as breast symptoms, pain, heavy bleeding, vaginal discharge, or itching. Depending on your age and your needs, the exam will also include screening for sexually transmitted infections, vaccine administration (the human papillomavirus vaccine specifically, though some clinics offer additional vaccines), and a discussion about birth control and family planning. 

For patients who have reached menopause or are currently experiencing perimenopause (also known as the menopause transition), the well-woman exam will include a discussion of symptom management and treatment. 

Some practitioners even incorporate other health screenings into the well-woman exam, such as mental health evaluations, drug and alcohol screening, and blood tests to check lipids and blood sugar levels. Finally, your provider will ask whether you are feeling safe at home. If the exams and screenings reveal anything that needs to be addressed, your provider will either create a treatment plan, order further testing (for example, a breast exam might be followed up with a mammogram—even if you are not technically due for one) or refer you to another healthcare provider. 

“It is highly recommended that [all] these evaluations be included, though the depth of the screening varies,” Garbus says, explaining that every office has its own policies and protocols.

With that said, be aware that while organizations like the American College of Physicians (ACP) and American College of Obstetricians and Gynecologists (ACOG) publish screening guidelines and recommendations for things like Pap smears and pelvic exams, individual providers tend to make determinations on the need for these and other tests based on a) their own experiences and opinions and b) the needs of the patient in question, explains Mary Jane Minkin, MD, a clinical professor in the department of obstetrics, gynecology and reproductive science at Yale University School of Medicine. 

So, for example, while ACP no longer recommends routine pelvic exams for asymptomatic women, many providers think it is prudent to conduct them as a preventive measure. “It is a joint decision between the provider and the patient,” Dr. Minkin says, adding that she personally considers them an important part of the exam (as does ACOG).

How to prepare for your well-woman exam

One of the most important things a woman can do to prepare for a well-woman exam is to get it on the calendar. Many providers have long waits, especially for new patients, so be sure to call the scheduling department long before you are due for your exam. As long as your visit is routine, expect to spend about one hour at the clinic. 

When the day of your appointment arrives, Dr. Minkin says it is important to show up with a list of questions and health concerns at the ready so you don’t forget to bring anything up that you want to discuss. You can also find a checklist for health living at each age at womenshealth.gov. 

“Any question that you have, write it down,” she says. This could include questions about symptoms, medications, fertility, future pregnancies, or even the nature of the appointment itself.

And don’t worry about whether you think the question is worthy of your doc’s time. After all, this is your appointment, says Garbus. Any question is fair game.

“The provider isn’t necessarily going to be able to anticipate every question,” she says. “So if you have a question or are even just vaguely curious, you [should] definitely feel comfortable asking.”

Dr. Minkin also recommends that patients be prepared to discuss their birth control methods, in case changes need to be made (if you frequently forget to take your pill, for example, it might be a good time to try something different, like an IUD). 

Your provider will have questions for you, as well. And while some of them will seem very personal (i.e. questions about your sexual activity and partners), it is important to be honest and straightforward so you can receive the appropriate testing and care. 

If you are nervous about the appointment or just want some moral support, it is okay to bring someone along to your appointment (like your partner or a friend), says Garbus. 

“This is your visit … and if you feel like having someone (else) in the room with you will make you feel more comfortable during the exam, you have the right to ask for that,” she says. “We always welcome anything we can do to help you feel more involved.”

However, the provider will still need some time alone with the patient, Garbus and Dr. Minkin say, to ensure that critical matters like intimate partner violence or a young woman’s need for birth control don’t get overlooked. What you say to your doctor is confidential, so you should feel comfortable opening up.

“We need to give (the patients) time to feel safe and free to confide in us,” Dr. Minkin says. 

In terms of timing, a well-woman exam can take place at almost any point in your menstrual cycle, Dr. Minkin says. The exception? If you are experiencing unusual discharge your exam should not coincide with the heaviest day of your period.

“If someone is bleeding heavily it could be tricky to interpret [those] results,” Dr. Minkin explains. 

As for the cost, the Affordable Care Act mandates that preventive care such a well-woman exams are fully covered by most health insurance plans. That means no out-of-pocket cost to you, as long as you have insurance. If you don’t have health insurance, the cost will depend on who you see and what sorts of tests are ordered. If you can’t afford your exam, free cancer screenings are available through the National Breast and Cervical Cancer Early Detection Program. Planned Parenthood also offers low or no-cost exams to those who qualify, as well.

Why do I need a well-woman exam?

What if you are happy with your birth control method, are having normal periods, don’t plan to become pregnant anytime soon, and aren’t experiencing any strange or concerning symptoms? Do you still need regular well-woman exams? Yes. The U.S. Department of Health and Human Services recommends that all women get them yearly.

You won’t need every component of the exam at every visit, though. Women under the age of 21, for example do not need Pap smears at all, Dr. Minkin says. Neither do most women over the age of 60, says Garbus. The U.S. Preventive Services Task Force recommends women get Pap smears every three to five years. Pelvic exam frequency varies based on the provider and the needs of the patient, and STI testing and vaccines are given on a case-by-case basis (depending on the patient’s needs at the time of the visit). 

Furthermore, well-woman exams are not required for women under the age of 18, although those who are either sexually active or experiencing painful periods (or other concerning symptoms) should see a provider sooner. Women who have reached menopause should keep up with their annual well-woman exams, as well. The idea, says Garbus, is to prevent problems from happening and to catch existing problems early on.

“A lot of this, at times, can just feel routine,” she says. “But [at the exam] we can delve into a whole lot of things that could come up down the road.”