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A New Road Map for Women’s Health

Reinventing Women’s Wellness Exams During the Time of COVID-19

by Mary Beth TeSelle and Deborah Chong, MD
New recommendations say that most women between the ages of 21 and 65 do not need a wellness exam, including Pap smear, every year and may be able to extend their exam to every five years.

Many things have changed during the past year due to COVID-19, including how we manage our health. What was once a quick and easy decision to visit the doctor, is now a hesitant debate, weighing the pros and cons of whether an appointment is really necessary, whether the issue could be handled virtually, and, for some, whether it can be ignored completely.

While all doctors agree that seeking medical care remains safe and that everyone should seek care when needed, there are some changing beliefs when it comes to preventive care.

“Traditionally, women were asked to see their gynecologist every year for a Pap smear and breast exam, as well as routine health maintenance,” explains Deborah Chong, MD, OB/GYN with Dignity Health Medical Group – Sierra Nevada. “With the advances in research and technology, those recommendations have changed.”



Deborah Chong, MD

Dr. Chong says the recommendation now is that most women only need Pap smears with HPV testing every 3-5 years, depending on her age and other risk factors.

“One of the contributing factors to this decrease in frequency is the ability to now easily test for the Human Papilloma Virus (HPV),” says Dr. Chong.



Dr. Chong explains that because HPV is known to be the cause of more than 99 percent of cervical cancers, the fact that physicians can find HPV before cancer develops means the cancer screening (the Pap smear with HPV testing) does not need to be done so frequently.

“The HPV testing is technology that was not available 15 years ago, when the annual Pap smear was still recommended,” she says.

Given these factors, Dr. Chong says the current recommendations for women’s wellness exams, by age, are:

21 – 30 years: Test every three years, and if it is abnormal then check for HPV. If your HPV results are normal, then depending on your age group, you do not need to have another Pap for 3-5 years.

30 – 65 years: It is recommended to have your Pap smear with HPV tested every 5 years.

“An important note to these guidelines – if you are immunocompromised for any reason, including being HIV positive or if you are a transplant patient and are on immuno-suppressive drugs, you may need a Pap smear more often,” Dr. Chong explains. “If you also have had an abnormal Pap smear or are positive for high-risk HPV, then you may need more frequent surveillance.”

Dr. Chong says there is also a population of women who do not need to have a Pap smear at all.

“Even if you are sexually active, if you are under the age of 21, we do not recommend a Pap smear, though we do recommend getting tested for sexually transmitted infections,” she says. “If you have had a hysterectomy for reasons other than cancer or pre-cancer and have never had an abnormal Pap smear, you no longer need a Pap smear. And if you are over 65 and have never had an abnormal Pap smear, you no longer need Pap smears.”

Of course, the traditional women’s wellness exam includes more than just a Pap smear – it also includes a pelvic exam. Dr. Chong says that too has been reevaluated.

“None of us know anyone who enjoys coming to the doctor to have their pelvic exam done,” she says with a laugh. “This is a huge inconvenience for women to have done yearly, especially if you are feeling healthy.”

Dr. Chong says pelvic exams are unnecessary unless you have symptoms such as pain, fullness or irregular bleeding.

The final aspect to every woman’s wellness exam should be an honest, open conversation with her doctor about her health and any concerns or questions she has.

“A wellness visit is a time to optimize your health with your primary care doctor. Your OB/GYN can help with the pelvic and breast exam, though this is often done by the primary care doctor as well,” Dr. Chong says. “A visit with the primary care doctor is a time to make sure all your screenings are up to date, such as cholesterol, blood pressure, colon and breast cancer screening, sexually transmitted infections and other potential health screenings depending on your age and other risk factors.”

Dr. Chong reminds women that your doctor wants to keep you safe and healthy through the pandemic and beyond. With her approach as a holistic gynecologist and a fellowship in herbal medicine, she likes to discuss nutrition, lifestyle, stress reduction and potentially herbal supplements to improve health and wellness. She points out that this conversation doesn’t have to be in person and can be done through telehealth.

“During the pandemic, we have been asked to stay at home as much as possible,” she says. “A telehealth visit is an optimal way to achieve these goals if you are not due for a Pap smear. Mammograms can also be ordered through telehealth as most microscopic breast cancers are detected via imaging, and not necessarily by breast exam performed by your doctor.”

Both Dr. Chong and her partner Dr. Lystra Wilson-Celestine are happy to see you over telehealth for numerous OB/GYN related issues and routine prescription refills. To learn more, call their office at 530.477.3119.

 


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