Periodic well-woman visits may be provided by a gynecologist, other women's health clinician, or primary care clinician.
Recommendations vary regarding the frequency of primary care or gynecologic preventive care visits. The American College of Obstetricians and Gynecologists (ACOG) recommends well-woman visits every year for all women who are sexually active or > 18 years. The ACOG recommends that these visits include screening, evaluation, counseling, and immunizations based on age and risk factors.
Well-woman visits should include taking a comprehensive medical history, including current symptoms or concerns as well as medical, surgical, gynecologic, obstetric, family, and social history, as well as medications and allergies. Although these visits are typically called "well-woman" visits, taking a gynecologic history may also be relevant for patients who are gender diverse (1).
During a well-woman visit, patients may be screened for or counseled about
Safer sex
Preconception care
Perimenopause and menopause
Depending on history of vaccination for human papillomavirus (HPV) and age of the patient, HPV vaccination should be offered. People who are not infected with human immunodeficiency virus (HIV) but are at high risk (eg, having a partner who is living with HIV, high-risk sexual behaviors, or illicit injection drug use) should be counseled about and offered preexposure prophylaxis with antiretrovirals (PrEP), if appropriate (2).
General health screening and counseling, such as for diabetes, hypertension, or dyslipidemia and other topics, and to encourage a healthy diet and physical activity, are addressed as part of a well-woman visit by primary care clinicians and some gynecologists.
Pelvic Examination
The decision to perform a pelvic examination should be a shared decision between the patient and clinician (3). Pelvic examinations may be performed if indicated based on symptoms, as part of routine preventive care screening, or if a woman expresses a preference for the examination after reviewing the risks and benefits. There are inadequate data to support recommendations for or against performing a routine screening pelvic examination among asymptomatic nonpregnant patients who are not at increased risk of any specific gynecologic disease (eg, ovarian cancer, uterine cancer) (4). Also, pelvic examination is not indicated for initiation or renewal of contraception, except for an intrauterine device.
Women with risk factors for gynecologic cancer (eg, history of cervical dysplasia, in-utero exposure to diethylstilbestrol [DES], or prior gynecologic malignancy) may require more frequent screening and should be managed according to current guidelines.
Breast Examination
Like the pelvic examination, the decision to perform a breast examination should be a shared decision between the patient and clinician and performed when indicated by medical history or symptoms or if the patient expresses a preference for the examination (5).
References
1. American College of Obstetricians and Gynecologists’ Committee on Gynecologic Practice: Opinion No. 823: Health care for transgender and gender diverse individuals. Obstet Gynecol 137 (3):e75–e88, 2021. doi: 10.1097/AOG.0000000000004294
2. American College of Obstetricians and Gynecologists (ACOG): ACOG Practice Advisory: Preexposure Prophylaxis for the Prevention of Human Immunodeficiency Virus, June 2022
3. American College of Obstetricians and Gynecologists’ Committee on Gynecologic Practice: Opinion No. 754: The utility of and indications for routine pelvic examination. Obstet Gynecol 132 (4):e174–e180, 2018 (reaffirmed 2020). doi: 10.1097/AOG.0000000000002895
4. US Preventive Services Task Force, Bibbins-Domingo K, Grossman DC, et al: Gynecological Conditions: Periodic Screening With the Pelvic Examination. March, 2017
5. American College of Obstetricians and Gynecologists’ Committee on Gynecologic Practice: Practice Bulletin Number 179: Breast Cancer Risk Assessment and Screening in Average-Risk Women. Obstet Gynecol. 2017 (reaffirmed 2021);130(1):e1-e16. doi:10.1097/AOG.0000000000002158
6. Feltner C, Wallace I, Berkman N, et al. Screening for Intimate Partner Violence, Elder Abuse, and Abuse of Vulnerable Adults: An Evidence Review for the U.S. Preventive Services Task Force [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2018 Oct. (Evidence Synthesis, No. 169.) Appendix F Table 1, IPV Screening Instruments. Available from: https://www.ncbi.nlm.nih.gov/books/NBK533715/table/appf.tab1/
7. Laelago T, Belachew T, Tamrat M. Effect of intimate partner violence on birth outcomes. Afr Health Sci. 2017;17(3):681-689. doi:10.4314/ahs.v17i3.10
