Health Advocacy: Your Annual Gynecological Exam

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Every woman I know loves her annual visit to the lady-doctor. After all, there's nothing more fun than your yearly gynecological exam, right? Let's be honest, climbing into those stirrups is rarely anyone's favorite time of year, so let's talk about how to make the most out of your annual exam.

If you have health insurance, it will cover a free yearly exam to your gynecologist. Ladies, please use this visit. You paid your premium, use the free benefits it will cover! Plus, your annual exam is a great opportunity to connect with your doctor and get your questions answered. Let's be honest, the fact that our reproductive system is inside our body means that we can't see it, so we often don't think about it. We may not notice potential health concerns, so it is really important to see your gynecologist every year for a check up.

Before Your Visit

  • Schedule your appointment. Be sure to tell the scheduler you are booking an "Annual Preventative Care Services Visit."
    • If you book online, be sure to schedule a preventive care visit. Some health insurance companies don't list this automatically under gynecology appointments - call the appointment center to schedule over the phone if you do not see the words "preventative care" when booking online.
  • Call your insurance company before your visit.
    • Ensure that your visit will be free. Sometimes they get fussy about the date of your visit (it needs to be 1 year after your last visit), so ensure they will not charge you a copay/coinsurance.
    • Ask about charges for any labwork. Your pap smear should be free. Some STI (sexually transmitted infection) tests will have a fee, take notes on how much any potential labs cost so you can be prepared and make an informed decision about ordering labs.
  • In the days leading up to your appointment, do a self breast exam.
    • Ideally, you are doing regular self breast exams. If you aren't, be sure to do one before your visit to feel what your breast tissue regularly feels like.
    • Breast tissue is rarely uniform. Get familiar with your own breasts, which parts feel softer and which parts feel more fibrous? Being aware of your own breast tissue is key to setting a baseline so you can be aware of any changes.
    • If you have any questions about your breast tissue, jot down where you thought it felt "funny" so you can go over it with your doctor. Your doctor will be able to help you determine whether or not this is an area of concern.
  • Prepare a list of questions/symptoms you'd like to discuss with your doctor. Here are some ideas to get you started.
    • Any areas of concern that arose during your self-breast exam.
    • Concerns you have about your period, such as
      • spotting throughout the month.
      • length of your bleed (ideally, your period is 3-8 days).
      • Length of your cycle (ideally, your cycle falls within the range of 26-32ish days). Remember that Day 1 of your personal month is the first day of your bleed. The last day of your cycle is the day before you bleed again.
      • Regularity of your cycle (ideally, your cycle length varies by 1-3 days max. For example, your cycle ranges from 26-29 days rather than 26-32).
      • gynecological pain, and when it occurs (eg with your period, mid-cycle, etc.).
      • PMS symptoms that bother you.
    • If you changed to a new birth control within the past year, mark down any other changes you have noticed, such as symptoms that accompany your period, emotional changes, etc.
    • Do you experience pain or bleeding with sex? Write it down.
    • Pregnancy goals.

At Your Visit

  • I prefer to talk to my doctor with my pants on. I start the visit by letting them know I brought some questions that I would like to go over once I am dressed. Figure out what's best for you, but let your doctor know at the start of your visit that you brought your own questions. Doctors often have a script they will follow, so you want to be sure your doctor makes time for your comments as well.
  • Tell your gynecologist that you want this to be coded as a preventative visit. This is key to avoid unexpected billing charges, especially if you have already had a physical this year. The folks who process the billing codes are rarely doctors and they may make a mistake if you have already used a preventative care visit in the same year.
  • Review your list of questions with the doctor.
    • If the doctor is using words you don't understand, let her/him know! Ask your doctor to slow down and explain to you their thoughts in plain language. You have a right to know what they are saying.
    • Take notes! Write down the answers to your questions so you can refer back to them later.
  • Discuss your current birth control plan with your doctor.  In recent years, I have seen doctors recommend IUDs to women at very high rates. IUDs work great for some ladies, but like all medical intervention, they come with a risk. Ask your doctor to review the risks with you of any birth control you choose.
  • Ask your doctor how often she/he thinks you need a pap smear. The recommendations change frequently and vary based on your health history.
  • Ask your doctor which STIs they test for routinely. If you have had one or more new partners since your last STI test, now is the time to request more labwork. Since you've already called the insurance company, you know how much these will cost. If the cost of STI testing through your health plan is too expensive, there are other options, such as the STD Clinic through Denver Public Health or Planned Parenthood.

After your Visit

  • Check your lab results to find out about your pap smear and other STI test results.
    • If your pap is abnormal, talk to your doctor about follow-up steps.
    • If any STI tests are positive, talk to your doctor about follow-up steps.
  • Continue doing self-breast exams at home at least once a month.

If you have any questions about your annual exam, how to approach it, what to ask, what is normal and what isn't, feel free to reach out! I am always happy to help you advocate for yourself at the doctor's office.