You look at the calendar and notice it’s that time of year again—you know, the visit to the OB/GYN for your annual exam. And you might be wondering: “I’m not going to have any more children, and my husband has had a vasectomy, can I just skip it?” Or: “I’ve had a hysterectomy, why do I need a Pap smear?” “Do I really need to visit the OB/GYN every year?

The answer to that question is an unequivocal YES! Women should be visiting an OB/GYN yearly from the time they are in their teens until the end of life, according to William Johnstone Jr., M.D., board certified OB/GYN specialist with Pinehurst Surgical Women’s Care Center. “I see women in their 80s and 90s, and I have seen a 110-year-old lady in here.”

Start early and continue on
The American College of Obstetrics and Gynecology recommends that Pap smear-testing and gynecological examinations should begin at age 18 or with the onset of sexual activity, according to Patricia Middleton, M.D., a board certified OB/GYN specialist with Richmond OB/GYN.

“Ideally, a woman should come in before the onset of sexual activity in order to discuss options regarding contraception, prevention of unwanted pregnancy and prevention of sexually transmitted infections,” Dr. Middleton says.

Dr. Johnstone recommends that women come in at 16. “Twenty-five years ago, girls were starting their periods at 12 and 13,” he says. “Now they are starting at age 9 and 10, so we’re trying to catch women early in their reproductive years to get them into a pattern of seeing someone yearly and learning what’s normal and abnormal, and answer their questions about things that are private.”

Women should be able to develop a rapport with their OB/GYN and be able to trust him or her. “That’s the kind of relationship we like to have,” Dr. Johnstone says. “You know your patients, you’ve seen them over the years, you deliver their babies and take care of them through their whole reproductive life.”

Even if you are past the age of birth control and babies, continuing with an annual exam as you age is very important. “The longer you live, the greater your risk of breast cancer,” Dr. Johnstone says. “And I think you need to have a pelvic exam and Pap smear every year, because women are undergoing changes to their cervixes as they age.”

As a woman ages, there is the risk that gynecological assessments get lost in the midst of chronic diseases such as hypertension and diabetes, Dr. Middleton says.

“Many times, the needed screening is not performed,” she says. “The past gynecological history, which may place the patient at high risk for cervical cancer, may not be noticed due to multiple medical problems that the primary care physician is managing.”

What happens at the annual exam
According to Dr. Middleton, annual exams are more than just a Pap smear. “The exam includes screening of gynecological problems based on age and risk factors,” she says.

Typically, at an annual exam, a nurse will take your weight and blood pressure and, in some cases, take blood and urine samples. Then the physician will come into the room and may listen to your heart and lungs, and examine your thyroid and abdomen.

The OB/GYN will do a clinical breast examination to look for any abnormalities. He or she will also order screenings for breast cancer with mammograms, which is recommended annually after age 40 by organizations including the National Cancer Institute, American Cancer Society and the American College of Radiology.

What women generally think of when they think of their annual exam is the pelvic examination and Pap smear. During the pelvic exam, the patient is on her back with her bottom at the very end of the table and her feet resting in stirrups. The physician checks the vulva and then begins the pelvic examination with a speculum that is inserted into the vagina, allowing the physician to see the vaginal walls and the cervix, and to check for any abnormalities.

Once the speculum is in place, the physician takes samples from the woman’s cervix to detect pre-cancerous cells or cancer of the cervix. This sample is called a Pap smear.

“The American College of Obstetrics and Gynecology recommends having a yearly Pap smear during your reproductive years,” Dr. Johnstone says.

Dr. Johnstone recommends continuing with Pap smears and pelvic exams throughout the post-menopausal years, even if a woman has had a hysterectomy. “Last year, I took 10 women to the operating room who had had hysterectomies, but they had abnormal Pap smears,” he says. “So you can still get changes in the vaginal mucosa in the area where the cervix was. Also, the pelvic exam allows you to check and see other things that might be going on: There’s vaginal carcinoma, vulvar carcinoma, which seems to be more prevalent in women the older they get.”

Other screenings and exams
Quite often, women think of their OB/GYN as the only doctor they need to see on a regular basis. “For many women, I’m the only doctor they see annually, so I do a full body exam on everyone—head and neck, listen to their heart and lungs, an abdominal exam—in addition to their breast and pelvic exam,” Dr. Johnstone says. “I do a rectal exam on women over 40, because we find about two cases of asymptomatic colon cancer a year doing that. And if they have a complaint, such as their eyes giving them a problem, or their ears, I will examine those.”

There are several things that should be checked regularly, either by a primary care physician or an OB/GYN. Recommendations on screenings vary based on the age and health history of the patient, so ask your health professional for guidance and recommendations on the following:

• Cholesterol screening
• Diabetes blood sugar test
• Thyroid test (TSH)
• Colorectal cancer screening by testing stool for blood, barium enema, sigmoidoscopy and colonoscopy
• Complete eye exam
• Skin exam for skin cancer
• Bone mineral density exam/bone mass measurement

Decisions about birth control
Modern birth control options include everything from the pill to the patch to the IUD. Deciding which birth control is right for you is truly a personal decision that should be made based on your personality and needs.

“The best way to accomplish this is to have an honest discussion of the choices, patient preferences, risks and benefits of proposed methods of birth control,” Dr. Middleton says. “For example, some patients can’t or won’t swallow pills; therefore, that patient should not walk out of the physician’s office with a prescription for birth control pills.”

Dr. Middleton recommends that women research the risks and failure rates of all birth control methods and be honest with their physician when they have concerns about a particular method.

“Some things you may have heard may not be true, or the risk may actually be low,” she says.

The birth control pill is Dr. Johnstone’s preferred method because of the long history of women using them. “They are low dose, easy to take and have very few side effects,” he says.

As long as a woman is not smoking, she can take birth control pills up until age 55, according to Dr. Johnstone. “There are some beneficial effects of being on birth control pills long term,” he says. “We used to think that you would have to take a holiday from them every two to three years, but that’s not true.”

Diaphragms and condoms are effective birth control methods, but only if the user is motivated.

“They don’t work in the box,” Dr. Johnstone says. “I recommend the condom not only for birth control, but to all my sexually active single patients, because it is the No. 1 option for preventing sexually transmitted diseases, and it’s very effective if used properly.”

IUDs are a good, cost-effective choice of birth control if you are almost completely sure that you have completed your family. “The IUD can sometimes create changes inside the uterus that can make it more difficult to get pregnant in the future, so it’s a good choice for women who are considering having their tubes tied, but are just not quite ready to do that,” Dr. Johnstone says.

There are many options for having your tubes tied as well. “There are clips, and there are bands, and there are cauterizations of the tubes—all of which are very effective,” says Dr. Johnstone. “There is one new procedure where you can put plugs in the fallopian tubes from within the uterus.”

You should be as sure as you can possibly be that you are done having children, though. “I ask my patients to be 200 percent sure,” Dr. Johnstone says. “No insurance company is going to pay to have it reversed, so while it may be reversible, you will have to pay for it.”

Hysterectomy
A hysterectomy is an operation to remove the uterus, and some operations include the removal of the ovaries. There are many conditions that can indicate the need for this procedure.

“A hysterectomy can be indicated for heavy, irregular bleeding that is not responsive to hormone manipulation,” Dr. Johnstone says. “It can be for prolapsed uterus, the management of fibroids, or for ovarian, uterine and cervical cancer. Also, for women who have incontinence surgery or bladder surgery, we recommend that the uterus come out as well, because it can actually pull down or act against the support treatment that you are doing.”

Most hysterectomies are performed under general anesthesia; some, under spinal anesthesia. And there are several options for the how the procedure is done.

“I do my hysterectomies vaginally,” Dr. Johnstone says. “It can be done abdominally, with a laparoscope, and there is a newer procedure called a supra cervical hysterectomy, which leaves the cervix intact.”

Recovery time for hysterectomies is fairly quick. “I send all my patients who have a vaginal procedure home the same day,” Dr. Johnstone says. “And they are fully functional within the month if they don’t have any other problems.”