What Gynecological Examinations Are Essential for Women of Childbearing Age?

Cervical Cancer Screening

Screening can begin 3 years after sexual activity starts or after the age of 21. Cervical cancer is currently the only gynecological cancer that can be prevented through vaccination and screening. Active screening effectively reduces the risk of cervical cancer.

It is recommended to undergo both TCT (ThinPrep Cytologic Test) and HPV (Human Papillomavirus) testing. If both results are normal, repeat screening every 3–5 years.

If either result is abnormal, active treatment is required, and the frequency of follow-up tests should follow the doctor's instructions. For women under 25 (or under 30 in some countries) without high-risk sexual behavior, TCT alone may suffice without routine HPV testing. However, if TCT results are abnormal, further HPV-related testing is advised.

This approach carries a slight risk of missed diagnoses. For more accurate results, combined TCT and HPV screening is preferable.

Women over 65 with 20 years of regular, normal screenings may discontinue screening.

Reproductive Health Examinations

Infertility is defined as the inability to conceive after 12 months of unprotected intercourse. Women with fertility concerns may consider reproductive health examinations.

Common tests include: hormone level checks, ovulation monitoring, thyroid function tests, gynecological ultrasounds, and fallopian tube patency tests. Specific tests should be determined by a healthcare provider.

Additionally, women of childbearing age should seek medical evaluation if experiencing the following symptoms:

1. Abnormal Vaginal Discharge

Normal discharge is white, thin, and odorless. Changes in color (e.g., yellow/green), increased volume, foul odor, or itching warrant medical attention.

• Tests: External/internal vaginal exams + discharge analysis to diagnose vaginitis.

2. Menstrual Disorders

A typical menstrual cycle lasts 21–35 days, with bleeding for 2–7 days (30–50mL blood loss; >80mL is abnormal). Irregular cycles, prolonged bleeding, or abnormal bleeding require evaluation.

• Tests:
  • Physical exam to rule out structural issues.
  • Common tests: CBC, coagulation tests, pregnancy test (hCG), ultrasound, hormone panels, thyroid function, hysteroscopy.
  • Testing varies based on symptoms.

3. Lower Abdominal Pain

Pain may indicate pelvic inflammatory disease, ectopic pregnancy, ovarian cysts, or other conditions. Non-gynecological causes (e.g., appendicitis) must be excluded.

• Tests:
  • Physical + pelvic exams to locate pain.
  • Possible tests: CBC, CRP, hCG, ultrasound, laparoscopy, culdocentesis.

4. Pelvic Masses

Masses may be palpable or detected incidentally during exams for other symptoms (e.g., pain, bleeding).

• Tests: Pelvic exam + ultrasound.

5. Vulvar Itching

Often linked to vaginal infections or localized conditions (e.g., lichen sclerosus, eczema).

6. Urogynecological Issues

Urinary incontinence, prolapse, or related symptoms (common postpartum/perimenopausal) warrant evaluation at a urogynecology or pelvic floor clinic.

Preparing for Gynecological Exams

• Clothing: Wear loose pants or a skirt; avoid jumpsuits/tights.
• Sexual activity: Avoid intercourse, douching, or vaginal medication 48 hours prior if testing for discharge/itching.
• Virginity: Inform the doctor if no prior vaginal penetration; transabdominal (full bladder) or transrectal ultrasounds may substitute.
• Fasting: Usually unnecessary unless liver function tests are required.

Optimal Timing for Exams

Timing relative to the menstrual cycle improves accuracy:

• Ovarian reserve tests (hormones/ultrasound): Days 2–4 of menstruation (AMH is cycle-independent).
• Ovulation monitoring: Start around day 10.
• Luteal phase defects: Mid-late cycle blood tests.
• IUD insertion/removal, cervical screening (TCT/HPV), tubal patency tests: Days 3–7 post-period (avoid intercourse/douching beforehand).