Your “Not-So-‘W​ell’-Woman​-Exam” at every decade–Teen-20’s

“March Madness” is all about “March Wellness” at

If so, some of your fears of going to the gynecologist have been replaced by knowledge of what actually happens at your “well-woman” annual gyne visit.  You have hopefully been engaging in fact based conversations with your girlfriends about HPV and cervical cancer, as well as Pap-tests and why not getting screened every year is actually ok for some women.
If so…I’m LOVING it!  My goal in starting this website was to provide you with enough knowledge that would give you the courage to engage in meaningful interactions having to do with your body and health.
But, what happens when you are scheduling a visit to the gynecologist because something is not going right? 
Every decade in our life presents different health concerns and therefore our gyne exam is based on these age-specific issues.
Here is a general guide on what women should focus on at each decade in their life and the corresponding workup to expect at their gynecology visit.
The list should help you be ready for your exam and know what concerns or problems to bring up with your gynecologist.
Remember, these are only general guidelines and by no means is this an all encompassing list of all the problems that can arise or a particular physicians approach to a problem.  If you have a specific problem, feel free to send me your questions/comments below.
(Mom’s of Teens…”Listen up!!”)
The American College of Obstetricians and Gynecologists (ACOG) recommends that the first visit to the ob-gyn take place between 13-15 years of age. But don’t worry this visit generally does not include a pelvic exam, but if you are sexually active then a speculum exam is in order to perform STI cultures.
If not, the focus of this visit is on patient education and to establish the doctor–patient relationship.
A discussion on anatomical development, body image, self-confidence, weight management, immunizations (including the human papillomavirus vaccine), contraception, and prevention of STIs is an important part of a teenagers health and prepares them to make difficult decisions.
A large part of my teenage visits are reproductive education and contraceptive initiation.  This is often done or initiated by mom…but not always.  If you think your daughter is having sex or thinking about it, ask her.  Better you than her friends!  And believe me mom, they are talking about it, and many doing it!
The rate of abortions in the U.S is down to its lowest this year since 1973 when abortions were made legal (“WootWoot!”). 
A big part of that is due to the fact that as women we have so many options for birth control other than just the pill such as long acting reversible contraception like intra-uterine devices called IUD’s and sub-dermal implants.
Be ready to discuss these options with your doctor.
Dysmenorrhea (DIS-men-or-ria) is the medical word for painful menses that in addition to abdominal cramping can also be accompanied with symptoms of nausea, vomiting, diarrhea, headache, dizziness, or back pain—yeah major PMS!
It starts 1-3 days prior to the onset of your menses and can last the entire cycle.  And, it obviously has an effect on your day to day life.
60-93% of adolescent women suffer from this condition month to month but only 15% seek medical attention.
That’s crazy to me.  I think that this is one of those female perpetrated actions that we don’t even realize occurs.  It is very common that the mothers of these young girls also had painful menses and feel that it is either “normal” or that you have no other choice than to suffer through it like they did.
“Here’s a hot pack and a few Midol, honey”
In reality, many young women are missing school, work, sports….pretty much sitting in the “Red Tent” all over again.
So mom’s…please!  Bring your girls in to the gynecologist, it’s not normal to be out of commission for days at a time due to pain and bleeding from your menstrual cycle….we can help!
The cause is usually prostaglandins from the endometrium (inside lining of the uterus) that make the uterus contract and inflamed more than usual.
The treatment is either non-steroidal anti-inflammatory (NSAID’s) medication, or oral contraceptive pills (OCP’s).
OCP’s are safe in young girls and are now available in very low doses.  They help in dysmenorrhea by preventing ovulation and decreasing blood flow during menstruation.  They are a medication, not a “start having sex immediately” card.
Ahhh….to be in my 20’s again!
Young and carefree!  The most important thing for your health maintenance is trying to get some sleep.
The majority women in their 20’s are not sleeping or eating the way they should be.  Looking good is important for you and so is getting to the gym.  But if you are not replenishing your body with rest, water and the nutrients it needs…it will eventually crash.
Building up your immune system is important for many reasons, but remember that up to 80% of young women will be in contact with HPV virus by their early 20’s and if your immune system is healthy you will likely clear it up on your own.  If not, then you will increase the likelihood that the virus will stay in your body and cause problems that can lead to cervical cancer.
HPV vaccine is available until age 26 and this should be part of your health screening as well as condom use, drug and alcohol abuse, and rape prevention and education.
A common complaint of women in their 20’s is pelvic or lower abdominal side pain that is associated with an ovarian cyst or mass.  The great majority of ovarian tumors occur during our reproductive years and are mostly benign masses.  This is because most ovarian masses are related to our menstrual cycle and reproductive hormones.
A pelvic ultrasound is performed to assess the size, location, and characteristics of the mass.  Depending on theses findings and your symptoms, a decision will be made to either follow up with a repeat ultrasound or to undergo more definitive management like surgery.
Some pelvic masses can be caused from an infectious process like gonorrhea or chlamydia and may be associated with fever and pain. This requires immediate treatment and you should call your doctor.
Any abdominal pain, bleeding, and a positive pregnancy test can be a miscarriage or an ectopic pregnancy (a pregnancy that has implanted outside of the uterus and can outgrow its space and blood supply).  This can be a medical emergency, always call your doctor to describe your specific symptoms.
If you are having any abnormal vaginal discharge let your gynecologist know so that a vaginal swab can be done to detect any vaginal infections.   The most common signs include a white, clumpy, itchy discharge which is typical of yeast; or a watery, yellow-greenish, foul smelling discharge which is usually bacterial vaginosis.
A discussion about your reproductive planning should also be had whether that is starting contraceptives or planning a pregnancy.  Remember there are many options for birth control these days, it’s not a one size fits all.  Sometimes it may take a few tries to find the method that is right for you, so be patient.  And don’t be afraid of discussing the long-acting-reversible-contraceptives like intra-uterine devices and sub-dermal implants with your gynecologist–they might be just right for you!
Stay tuned tomorrow for health and not so healthy in your 30’s and 40’s!