When should I start having an annual visit?

Historically, your first trip to your gynecological provider is when you are due for your first pap. While plenty of people still choose to do this, it can be helpful to see your provider as early as when puberty starts to discuss gynecological care. A pediatrician is a great primary care provider for teens and young adults, but seeing a GYN provider from an early age allows patients to ask more specific questions and lower their anxiety for when breast and pelvic exams begin a few years later.

Gynecological exams are usually started at age 21 in order to have your first pap test, which is a screening test for cervical cancer. Screening breast exams typically start at age 25. However, if you notice changes in your breast tissue prior to age 25, please make an appointment with your provider to assess the changes and determine if any further testing is needed, such as a breast ultrasound.

What will the exam entail?

During your annual visit you will have an exam which will include listening to your heart and lungs, feeling your lymph nodes to assess for swelling or pain, and checking your thyroid for any enlargement or abnormal growths. It may also include a breast exam and a pelvic exam. The breast exam will check for any lumps, pain, dense tissue, skin changes, or discharge. You will also review how to perform a breast exam at home so you can learn to identify any of these changes. 

A pelvic exam is a general term for an exam of the vulva and the vagina. On the vulva we check for any irritation, skin changes, or growths. To be able to see into the vaginal canal we use a device called a speculum, which holds the walls of the vagina and is typically in place for less than a minute. Specula (the plural of “speculum”) can be made from either metal or plastic. To decrease discomfort during this exam, your provider may recommend positioning of your body in addition to using lubricant on the speculum. For most people, the speculum feels like pressure, but isn’t painful. If you are experiencing pain during this exam, notify your provider so you can discuss strategies to resolve it. If this is your first pelvic exam, telling your provider can help so you can discuss what to expect. The testing that is done while the speculum is in place is a pap test and/or testing for some sexually transmitted infections (STIs), such as gonorrhea and chlamydia. The pap test may feel like mild scratching or cramping for about 10 to 15 seconds. The test for STIs may feel slightly dry and scratchy for a few seconds as it is done with a dry cotton swab like a Q-tip.

You can stop your provider at any point if you are feeling uncomfortable during your exam. We can either discuss ways to help make you more comfortable, or we can discontinue the exam entirely if you would prefer. You should never feel pressured by your medical provider to have any type of exam if you do not feel comfortable.

If I’m having another problem, can I still have my annual?

You should always discuss with your provider if you have another problem you would like to address during your annual visit. However, depending on the problem, you might be encouraged to schedule an additional visit to better address your needs. Some insurances do not cover the costs of both an annual visit and a problem visit during the same appointment. To avoid you having to pay unexpected costs if your insurance denies coverage for the appointment, it is best to check with your provider if your problem can be addressed at the same time. 

Similarly, you are not able to have a procedure at the same time as your annual visit. This means you will need a separate appointment for an IUD insertion or removal, Nexplanon insertion or removal, colposcopy, lesion removal, endometrial biopsy, or vulvar biopsy. These are lengthy visits and need their own time slot. In addition, they can be expensive if your insurance does not agree to cover the cost due to being performed at the same time as a preventive visit.

Do I need to go every year?

An annual exam is meant to focus on preventive care and testing. While the term “annual exam” is still widely used, it doesn’t necessarily mean you need to have one every year. It will largely depend on your age and your previous pap test results.

Some abnormal pap tests call for testing again in 1 year. This gives the cells of the cervix time to replace any cells that may have been damaged due to human papillomavirus (HPV). It typically takes 6 to18 months for this replacement of the cells to occur, which is why 12 months is chosen to repeat testing as it is the average between 6 and 18.

For breast exams, the recommendation is to have one done by a provider every 1 to 3 years from ages 25 to 39 and then yearly for those 40 and over.