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Well-Woman: Screening for Women Ages 19-39 Years

Me & My OBGNovember 13, 2014Articles

Annual assessments provide an excellent opportunity to counsel patients about preventive care and to provide or refer for recommended services. These assessments should include screening, evaluation and counseling, and immunizations based on age and risk factors.

well womanThese recommendations, based on age and risk factors, serve as a framework for care which may be provided by a single physician or a team of health care professionals. The scope of services provided by obstetrician–gynecologists in the ambulatory setting will vary from practice to practice. The recommendations should serve as a guide for the obstetrician–gynecologist and others providing health care for women and should be adapted as necessary to meet patients’ needs. This information should not be construed as dictating an exclusive course of treatment or procedure to be followed.

Screening

HISTORY

Reason for visit
Health status: medical/surgical, menstrual, reproductive health
Family medical history
Dietary/nutrition assessment
Physical activity
Use of complementary and alternative medicine
Tobaccoalcohol, other drug use
Abuse/neglect
Sexual practices (including vaginal, anal, and oral sex; sexual orientation, number of partners; contraceptive use; exchange sex for drugs or money)
Urinary and fecal incontinence

PHYSICAL EXAMINATION

Height
Weight
Body mass index (BMI)
Blood pressure
Neck: adenopathy, thyroid
Breasts (clinical breast examination every 1-3 years beginning at age 20)
Abdomen
Pelvic examination: ages 19-20 years when indicated by the medical history; age 21 or older, periodic pelvic examination
Additional physical examinations as clinically appropriate

Laboratory and Other Tests

PERIODIC

Cervical cytology:
Age 21-29 years:
Screen every 3 years with cytology alone

Age 30 years or older:
Preferred: Co-test with cytology and HPV testing every 5 years
Option: Screen with cytology alone every 3 years

Chlamydia and gonorrhea testing (if aged 25 years or younger and sexually active)
Human immunodeficiency virus (HIV) testing (Physicians should be aware of and follow  their states’ HIV screening requirements. Visit the Centers for Disease Control and  Prevention for more information.)

HIGH-RISK GROUPS (See High-Risk Table for more information.)

Bone mineral density screening
Colorectal cancer screening
Diabetes testing

Genetic testing/counseling
Hemoglobin level assessment
Hepatitis C virus testing
Lipid profile assessment
Mammography
Sexually transmitted infection testing
Thyroid-stimulating hormone testing
Tuberculosis skin testing

Evaluation and Counseling

SEXUALITY AND REPRODUCTIVE PLANNING

Contraceptive options for prevention of unwanted pregnancy, including emergency contraception
Discussion of a reproductive health plan
High-risk behaviors
Preconception and genetic counseling
Sexual function
Sexually transmitted infections—barrier protection

FITNESS AND NUTRITION

Physical activity
Dietary/nutrition assessment (including eating disorders and obesity)
Folic acid supplementation
Calcium intake

PSYCHOSOCIAL EVALUATION

Interpersonal/family relationships
Intimate partner violence
Acquaintance rape prevention
Work satisfaction
Lifestyle/stress
Sleep disorders

CARDIOVASCULAR RISK FACTORS

Family history
Hypertension
Dyslipidemia
Obesity
Diabetes mellitus
Personal history of preeclampsia, gestational diabetes, or pregnancy-induced hypertension
Lifestyle

HEALTH/RISK ASSESSMENT

Breast self-awareness (may include breast self-examination)
Chemoprophylaxis for breast cancer (for high-risk women aged 35 years or older)
Hygiene (including dental)
Injury prevention
Exercise and sports involvement
Firearms
Hearing
Occupational hazards
Recreational hazards
Safe driving practices (seat belt use, no distracted driving or driving while under the influence of substances)
Skin exposure to ultraviolet rays
Suicide: depressive symptoms
Tobaccoalcohol, other drug use

Immunizations

PERIODIC

Diphtheria and reduced tetanus toxoids and acellular pertussis vaccine (substitute one-time dose of Tdap for Td booster; then boost with Td every 10 years)
Human papillomavirus vaccine (one series for those aged 26 years or younger and not previously immunized)
Influenza vaccine (annually)
Measles-mumps-rubella vaccine (for those not previously immunized)
Varicella vaccine (one series for those without evidence of immunity)

HIGH-RISK GROUPS (See High-Risk Table for more information.)

Hepatitis A vaccine (consider combination vaccine for those at risk for hepatitis A and B)
Hepatitis B vaccine (consider combination vaccine for those at risk for hepatitis A and B)
Meningococcal vaccine
Pneumococcal vaccine

Source: American Congress of Obstetricians and Gynecologists

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