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The annual gynecological visit — the well-woman visit — is the appointment where screening happens, contraception is reviewed, symptoms get raised, and problems are caught before they announce themselves. It is worth keeping even in a year when nothing is wrong.

Start with the thing most people have backwards. An annual visit does not mean an annual Pap smear. Cervical screening runs on a multi-year interval for most women. The visit is annual; the tests inside it are not all annual. Skipping the visit because "I don't need a Pap this year" is how blood pressure, breast changes and abnormal bleeding go unmentioned for years.

Who this visit is for

Any woman from adolescence onward. A first gynecology visit is recommended between ages 13 and 15, and that first appointment is usually a conversation with no pelvic exam at all. After that, an annual visit through the reproductive years, into perimenopause, and beyond. See when to see a gynecologist, by age for what changes at each stage.

What happens at the visit

The conversation. Periods, pain, bleeding, discharge, sex, contraception, mood, sleep, urinary symptoms, and anything you have been meaning to ask. This is the part with the most value in it, and it is the part patients most often cut short.
Vital signs. Blood pressure and weight. Blood pressure is checked here because for many women this is the only medical appointment of the year.
Physical exam. A general exam, a clinical breast exam, and a pelvic exam where it is indicated. If you are 21 or over and due for cervical screening, that happens now. A pelvic exam is not automatically required at every visit — if you are not due for screening and have no symptoms, ask whether it is needed this year.
Testing. Cervical screening if due, STI testing on request or by risk, and blood work where your history warrants it.
A plan. Which vaccines are due, which screenings are due next, what to do about anything you raised, and when to come back.

You can bring someone with you. You can ask for a chaperone. You can decline any part of the exam and still have the rest of the visit.

Screening by age, in plain terms

Cervical cancer screening. Begins at 21, regardless of when you became sexually active. Ages 21 to 29: Pap alone every three years. Ages 30 to 65: HPV testing every five years, HPV and Pap co-testing every five years, or Pap alone every three years. Screening usually stops after 65 with an adequate history of normal results. Details are in how often you need a Pap smear and colposcopy after an abnormal Pap.

HPV vaccination. Routine at ages 11 to 12, catch-up through 26, and available through 45 by shared decision-making. See the HPV vaccine.

Breast cancer screening. Mammography from 40, every one to two years, continuing to at least 74. Earlier or with additional imaging if you have a strong family history, a known genetic mutation, or dense breasts.

STI screening. Annual chlamydia and gonorrhea screening for sexually active women under 25, and for older women with new or multiple partners. HIV testing at least once for everyone aged 15 to 65. See STD testing and treatment.

Colorectal cancer screening. Begins at 45 for average risk.

Bone density. At 65 for average risk, earlier with risk factors such as early menopause, long-term steroid use, or a fragility fracture.

What gets raised here that gets missed elsewhere

Bleeding that has changed. Heavier, longer, between periods, after sex, or any bleeding at all after menopause. See abnormal uterine bleeding. Postmenopausal bleeding always needs evaluation.
Pain. Period pain that stops you functioning, pain with sex, or persistent pelvic pain is not something to normalise.
Contraception that no longer fits. Needs change. See birth control.
Perimenopause. Hot flashes, sleep disruption, mood change and irregular cycles in your forties are usually not a mystery and are usually treatable. See menopause management.
Bladder leakage and pelvic pressure. Common, under-reported, and treatable. See urinary incontinence.

How to get more out of the appointment

Write down your questions and hand over the list at the start, not as you are leaving.
Know your last period date and roughly your cycle pattern.
Bring your medication list, including supplements and anything you buy over the counter.
Know your family history of breast, ovarian, uterine and colon cancer, and at what ages.
Bring prior records if you are new to us, especially previous abnormal Pap results.

You do not need to schedule around your period. Cervical screening is best done outside heavy bleeding, but the rest of the visit is unaffected, and if you are bleeding abnormally that is a reason to come in, not to postpone.

Talk to us

Medical disclaimer

This page is general health information, not medical advice for any individual. Screening intervals are national recommendations for average-risk women and change with your personal and family history. Seek prompt care for heavy vaginal bleeding, severe pelvic pain, fever, or any bleeding after menopause.