Demystifying the well-woman: What to expect during this annual exam

If you’ve never had a well-woman exam before, you might be wondering what to expect. Is it similar to an annual physical? Which parts of your body will the doctor examine? And, which tests will be performed on you, and why?

We spoke with Elizabeth Keeler, M.D., a gynecologist who specializes in caring for women with cancer. Here’s what these important annual doctor visits include — and why you shouldn’t skip yours. 

A look at your reproductive medical history

Just as an annual physical with a primary care physician is designed to assess your overall health, a well-woman exam with a gynecologist is meant to gauge your sexual and reproductive health. So, an OB/GYN will likely start off your first visit by talking about your medical history, then move on to your menstrual cycle and sexual history. 

“Discussing such intimate topics with a new doctor can be awkward,” acknowledges Keeler. “But they have a valid reason for asking about these things.” 

Bleeding between menstrual cycles, heavy periods and bleeding during or after sex, for instance, can all be signs of both cervical and endometrial cancers in pre-menopausal women. Any vaginal bleeding can be a sign of cancer in post-menopausal women. And, the age at which you had your first period or had your first pregnancy can affect your risk of breast cancer. 

“That’s why it’s important to be candid with your doctor about whatever you’re experiencing,” says Keeler. “This is the first step in establishing a baseline of what’s normal for you.” 

A breast exam

The next thing that happens will likely be a breast exam. You’ll be asked to undress completely (if you haven’t already) and put on a hospital gown, with the opening to the front.

The doctor will then look at your breasts and gently press on them, both with your arms down at your sides and as you lift them over your head. This is to check for any lumps or visual abnormalities that could be early signs of breast cancer. They will also make note of any benign cysts. 

Depending on your age, you may be asked to get a mammogram. That’s a type of low-dose X-ray radiologists use to examine breast tissue in more detail. A mammogram can sometimes reveal lumps that are too small to be felt. 

“Every woman who is age 40 or older and at average risk for breast cancer should get a mammogram and a clinical breast exam every year,” notes Keeler. “Women at higher risk should talk to their doctors about what age to begin and how frequently they might need them.” 

RELATED: Learn how often you should get a mammogram

The pelvic exam: an exam in two parts

Your well-woman visit will also include a pelvic exam. For this, you’ll be asked to lie back on the exam table, place your feet up in the stirrups and let your knees fall to the side. A sheet is usually provided so you can cover yourself. 

During the first part of this exam, your doctor will inspect the outside of your vulva and anal area, then use a smooth metal instrument called a speculum to hold the walls of the vagina open so that they can see the surface of your cervix. They may also take samples of the cervix with what looks like a long plastic brush for a Pap test (also called a Pap smear) or an HPV test.

A Pap test and/or an HPV test

A Pap test is a screening test that detects pre-cancerous and cancerous cell changes in the cervix, while an HPV test is designed to detect multiple strains of the human papillomavirus.

“At least 12 different strains of HPV have been identified as ‘high-risk’ for causing cancer,” notes Keeler. “And the vast majority of cervical cancer cases are caused by HPV.”

In addition to cervical cancer, HPV has also been linked to anal, penile, throat, vaginal and vulvar cancers. That’s why it’s recommended that women start getting HPV tests at age 30 and their first Pap test no later than age 21. 

RELATED: Learn how often you should get a Pap smear or an HPV test

The pelvic exam: Part II

For the second half of the pelvic exam, your doctor will insert one or two gloved fingers inside your vagina while pressing on your lower abdomen with the other hand. The purpose of this is to make sure your internal and external anatomy both looks and feels normal.

“Though not an official screening test for ovarian cancer, pelvic exams can also reveal ascites, or fluid in the abdomen,” notes Keeler. “Ascites can be a sign of ovarian cancer, as well as fallopian tube cancer and endometrial cancer. Pelvic exams can uncover abnormal hard spots, too, that sometimes turn out to be tumors.”

If you’re over age 35, your doctor may also insert a gloved finger into your rectum to check for any masses there. “We can sometimes feel pelvic masses better through the anal wall,” Keeler explains, “and it’s an easy way to check for rogue anal masses, too.”

Additional tests you might need

If you’re age 65 or older, or you are menopausal and have other risk factors, your well-woman exam may involve a bone density test to check for osteoporosis, or bone loss. If you don’t have a primary care physician, your OB/GYN may also listen to your heart and lungs, and do a urinalysis and blood tests to check for liver dysfunction, diabetes, anemia and adequate vitamin D levels.

“Cancer is easiest to treat when it’s caught early on,” says Keeler. “And well-woman exams help us find some cancers at that stage. That’s why we strongly encourage women to get these annual check-ups starting at age 21 — and to make them a habit.”

Request an appointment at MD Anderson online or call 1-877-632-6789.