The ‘well woman’ visit
LET’S face it, the majority of Jamaican women only visit their obstetrician-gynaecologist (Ob/Gyn) when there is an issue with regards to bleeding, pregnancy, a sexually transmitted infection (STI) scare, infertility or pain. Women rarely visit their Ob/Gyn just for a check-up or for a friendly chat. But let me remind you all, we have been dubbed “The Female Physicians”, and we are some of the very few specialists whose doors are open to any woman and no referral is needed. Jamaican women need to be reminded of this, and need to take a walk through these doors at least once a year, and not just when there is an issue.
What is the ‘well woman’ visit?
The ‘well woman’ visit, or as insurance companies have called it, “the annual”, essentially refers to the woman visiting her physician yearly. The visit allows the Ob/Gyn to follow the maxim — ‘prevention is better than cure’ — by offering preventive care. Also, it provides an excellent opportunity to counsel patients on a healthy lifestyle and minimising health risks.
The visit should include screening, evaluation, counselling and immunisations based on age and risk factors. The physical examination includes a detailed general examination, and most women will have a pelvic examination and a clinical breast examination. Chronic conditions such as hypertension, diabetes, cancers (especially breast and cervix) and cardiovascular disease can be identified early at these visits and can be treated or prevented.
When should it start?
It is recommended that the first visit should be between 13 and 15 years of age. This visit generally does not include a pelvic examination and its sole purpose is patient education. Here pubertal changes, genital hygiene, contraception and prevention of STIs, weight management and menstrual disorders can be discussed. Most importantly, especially in Jamaica where cervical cancer is so prevalent, the role of the Human Papilloma Virus (HPV) vaccine should be discussed and encouraged to be taken prior to sexual activity.
For women older than 21, a pelvic examination should be performed annually. This provides an opportunity to offer Pap smears and also to screen for STIs with vaginal/cervical swabs. Also, pelvic masses such as fibroids and ovarian abnormalities can be detected.
The HPV vaccine can still be offered to women over 21 as it still may have some benefit in the prevention of cervical cancer.
It is recommended that a clinical breast examination be performed annually in women aged 40 years or older and every one to three years for women aged 20-39. Mammography can be offered annually for women older than 40.
When is the best time to pay your visit?
There is no specific time. I advise my patients to choose a time they will easily remember — like their birthday.
When should a woman stop her ‘well woman’ visits?
There really is no age limit for a woman to stop visiting her Ob/Gyn, as we are responsible for the woman for her entire lifespan. Some women may need extra counselling and medication when it comes to menopausal symptoms.
Post-menopausal symptoms such as bleeding may be early warning signs of gynaecological cancer, and can be identified early at the time of the ‘well woman’ visit.
Pap smears should be done until the age of 65.
So please, ladies, let’s make these visits routine!
Dr Daryl Daley is a consultant ObGyn at Gynae Associates, 23 Tangerine place, Kingston 10, and Shops 46-50, Portmore Town Centre, Portmore. He can be contacted at 929-5038/9, 939-2859, drdaryldaley@gmail.com or on Instagram @drdaryldaleyobgn.
