Women Empowered

Written by Kinsey Gidick

Step aside, diamonds. When it comes to health and wellness, a trusted OB/GYN is a girl’s best friend. Here, we share what to expect from—and how to get the most out of—this invaluable relationship

In 2018, 77.5 percent of the more than three million births in the United States involved prenatal care during the first trimester, according to the CDC. But while women are statistically good at seeking the care of an OB/GYN—or a specialist in obstetrics and gynecology—while they are pregnant, it’s a different story when it comes to standard care.

According to the journal Obstetrics & Gynecology, the number of women who regularly see an OB/GYN has declined over the last two decades. This disconcerting statistic flies in the face of proven health benefits associated with receiving an annual OB/GYN exam, says Dr. Elizabeth Richardson, an obstetrician and gynecologist affiliated with Roper St. Francis Healthcare.

From the first menses on through menopause, OB/GYNs help guide women through every phase of their lives. The obstetrics side of the specialty focuses on pregnancy, childbirth and the postpartum period. Meanwhile, gynecology provides routine care for the female reproductive system and includes regular screenings for conditions ranging from HPV and cervical cancer to polycystic ovary syndrome and endometriosis.

For some of these diseases, prevention and early detection can mean the difference between life and death, so the sooner a woman finds a gynecologist she feels comfortable with, the better, says Dr. Richardson. She adds that OB/GYN care isn’t limited to the reproductive organs. “During annual well visits, doctors monitor patients for a host of health conditions, from depression and osteoporosis to obesity, high blood pressure and more. We really take a look at the woman’s whole-body health.”

What to Expect

So what can you expect from a trip to your OB/GYN and when should those visits begin? As early as age 13, or whenever a young woman decides she would like to speak to a medical professional about her reproductive health, says Dr. Richardson.

• Teens & Early 20s. “Between the ages of 13 and 21, OB/GYNs provide a general health screening and make sure reproductive health is in order,” she explains. This can include counseling on irregular menstrual cycles or symptoms, safe sex practices (like use of condoms to prevent the spread of sexually transmitted diseases) and birth control. Doctors also perform a social and family history assessment to determine potential risk factors for disease. Based on the information gathered, an

OB/GYN may recommend an HPV vaccine, prescribe birth control or perform a pelvic exam (though the latter may not be needed at this age).

“The first appointment is often just an opportunity to get to know one another, to build trust and to ensure the woman is aware of ways they can protect their reproductive health,” says Dr. Richardson.

• 20s & 30s. Between the ages of 21 and 40, additional topics, including cancer prevention, enter the conversation. “We recommend women start receiving cervical cancer screenings at age 21,” says Dr. Richardson. In addition to a physical pelvic exam, this involves a Pap smear, during which the OB/GYN gently inserts a speculum into the vagina, which opens the vaginal walls to allow the doctor to see the cervix, or opening of the uterus. A small brush is used to collect a few cells, which are tested for signs of cancer or pre-cancer. In addition to cervical cancer, well-visit exams include screenings for breast cancer and, if concerning symptoms are present, colon cancer.Annual appointments during these decades and beyond cover much more ground, as well, like preconception counseling (things to consider before getting pregnant and smoking cessation support), immunization checks (reminders to stay up-to-date on your vaccines) and screenings for diabetes, high blood pressure and STDs. “These well visits also give women an important opportunity to discuss sensitive topics like partner violence and questions regarding sexuality,” says Dr. Richardson.
• 40s & Beyond. When a woman reaches age 40, the discussion expands to include perimenopause and menopause, as well. According to the North American Menopause Society, menopause is defined by the absence of menstruation for 12 consecutive months (barring other obvious reasons why). With the milestone comes a decrease in estrogen, which can cause a slew of symptoms ranging from hot flashes and night sweats to vaginal dryness and pain during sex. “We talk about what the woman is experiencing, how well they are coping with the symptoms and any treatment options they may want to consider to help manage symptoms, such as hormone replacement therapy,” says Dr. Richardson. Meanwhile, cancer screenings continue, as do screenings for osteoporosis and heart disease, the latter of which continues to be the leading cause of death among women in the nation.

FACTOID: The average age a woman experiences menopause in the U.S. is 51, though it’s common for it to occur anytime between ages 40 and 58.

How to Get the Most Out of Your OB/GYN Care

“The first and most important thing you can do is find an OB/GYN that you feel comfortable with,” says Dr. Richardson. Once you do, don’t skip your annual visits. “When performed as often as recommended, cancer screenings and general health exams let us catch disease as early as possible, which greatly improves our ability to treat it,” says Dr. Richardson.

Another step to receiving the best care possible, she says, is to be transparent. Dr. Richardson stresses that the OB/GYN office is a judgment-free zone. If you feel like you can’t be candid with your doctor, find a new provider. “There is nothing that you need to be hesitant about discussing with us,” says Dr. Richardson. “We are at the front line of women’s health and truly want to help you with any concerns that you have—whether that’s pain during sex, postpartum anxiety, waning libido or abuse of any kind. The more information we have, the better and sooner we are able to help you.”

Get Screened

Here, Dr. Richardson shares the latest recommendations for self-exams and in-office screenings for women. Note that the following reflect screening recommendations for women with an average risk for each condition. If you have a family history or other known risk factor, you may need additional screening. Talk to your OB/GYN to receive recommendations tailored to your unique risk.

• Breast cancer. The American College of Obstetricians & Gynecologists recommends a clinical breast examination every one to three years for women between the ages of 25 and 39. Women 40 to 75 (and possibly older) should receive an annual or biannual mammogram, in addition to an annual clinical exam. Monthly at-home self-checks are recommended, as well.
• Cervical cancer. Cervical cancer screening should begin at age 21. According to the American Cancer Society, women aged 21 to 29 should receive a Pap smear every three years; women ages 30 to 65 should receive a Pap smear combined with an HPV test every five years as long as results are normal or a Pap smear by itself every three years.
• Colon cancer. Regular colorectal cancer screenings should start at age 45. “If a patient of any age has a certain complaint—like if they notice blood in their stool—a gynecologist can perform a rectal exam,” says Dr. Richardson.
• Ovarian cancer. “Unfortunately, there are no good screenings for ovarian cancer,” says Dr. Richardson. “We take a careful look at family history to determine if a woman has any genetic predisposition for cancer. If she does, we may refer her to a genetic counselor, who will take a more in-depth family history and may offer testing for genetic disorders that could put her at increased risk for developing a condition like ovarian cancer.”
• Skin cancer. The Women’s Preventative Services Initiative recommends that annual skin cancer screenings start as soon as a woman makes her first OB/GYN appointment (or by age 20).
• Bone density. The National Osteoporosis Foundation recommends women receive a bone density scan at age 65. “Some risk factors may indicate that you should have it sooner, such as low body weight, smoking or history of fractures,” says Dr. Richardson. Results determine frequency going forward.
• STDs. Dr. Richardson recommends all women 24 years and under who are sexually active have an annual gonorrhea and chlamydia screening. “These infections are common in that age population and don’t always produce noticeable symptoms.”
• HIV. The CDC recommends that everyone between the ages of 13 and 64 be screened for HIV at least once in their lifetime. “People that are at increased risk for HIV should have more frequent testing,” notes Dr. Richardson. This includes individuals that have multiple sexual partners, use IV drugs and those that have been diagnosed with or treated for another STD.

Photographs (Dr. Richardson) courtesy of the doctor & (women) by Rawpixel.com/Shutterstock