Everything You Need to Know About Gyno Screenings

If you're not sure when or how often you're supposed to get screened for cervical cancer, breast cancer, HPV, and more, read on.

Disney Princess Gyno Appointment

Not sure when you're supposed to start going in for mammograms? Pretty sure you heard that pelvic exams aren't necessary anymore? Just generally confused about all things gynecological? You're not alone.

With all the changes in screening recommendations this past year, we realized we had no idea when and how often we were supposed to be screened for various conditions, including cervical and breast cancer. Which is, you know, kind of important.

So we asked Cherrell L. Triplett, MD, an obstetrician-gynecologist who practices at Southside OBGYN and Franciscan Alliance in Indianapolis, Indiana, to give us the lowdown on the four primary gynecological screening tests that are recommended for most adult women.

And we know no one likes thinking about trips to the OB/GYN. (No offense, docs!) Luckily artist Maritza Lugo makes going to the gyno a whole lot more fun with the help of some of our favorite Disney princesses.

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Pap Smears

Who: All women need Pap smears, regardless of whether or not they are sexually active.

What: A Pap test looks at the cells of the cervix to determine if there are any abnormalities. "Ultimately, the Pap smear looks for cervical cancer, but also can detect any pre-cancerous cells on the cervix," Dr. Triplett says.

When: Women should start getting Pap smears at age 21 and continue until they are 65. Women between 21 and 29 are recommended to have this screening about every three years; women 30 and older are recommended to have a Pap smear every three to five years.

"The Pap smear is one that has undergone recent changes over the last several years," explains Triplett. "Traditionally, women have been accustomed to having a Pap smear every single year. But the newest recommendations say that may not be the case."

Why: Regular Pap smear screenings reduce cervical cancer cases and deaths by at least 80 percent, according to the National Cancer Institute (NCI).

How: During an annual wellness exam, the patient lays on a table with her legs in stirrups. Her doctor inserts a speculum, a metal or plastic device shaped like a duck's bill, into the vagina, which allows the doctor to view the vaginal walls and the cervix. Samples of the cells are then taken to using a small brush-like instrument.

Pelvic Exam

Who: All women need pelvic exams.

What: A pelvic exam looks for any growths or abnormalities on your external and internal reproductive organs, including the vagina, uterus and ovaries, as well as the bladder and rectum. "A Pap smear just screens the cervix, but a pelvic exam screens everything else," Triplett says. "I always tell women they are more than their cervix."

When: Women should have a pelvic exam once a year, generally starting at age 21. "However, if women under 21 come in and say they need to be screened for a possible infection, a pelvic exam will be done then," Triplett adds.

But it's possible less is more: A 2014 review from the American College of Physicians (ACP) suggests the harms from an annual wellness visit may outweigh the benefits for some women.

"Routine pelvic examination has not been shown to benefit asymptomatic, average risk, non-pregnant women," said Linda Humphrey, MD, a co-author of the guideline and a member of ACP's Clinical Practice Guidelines Committee in a formal statement. "It rarely detects important disease and does not reduce mortality and is associated with discomfort for many women, false positive and negative examinations, and extra cost."

Why: The ACP did not find any studies that indicated annual pelvic exams have diagnosed serious medical conditions. But many gynecologists disagree and believe pelvic exams can detect uterine fibroids, ovarian cysts, as well as begin the dialogue about any other uncomfortable symptoms that need to be addressed.

How: "In most cases, the Pap smear is coupled with what we call the pelvic or bimanual exam, where we then place two fingers (lubricated and gloved) inside the vagina that allows us to evaluate the uterus and the ovaries, as well," Triplett says.

Just like a Pap smear, the patient lays on a table with her legs in stirrups. The doctor visually inspects the vulva, then inserts the speculum to look at the vaginal walls and cervix. Finally, as Triplett explained, the doctor inserts two fingers into the vagina with one hand and presses gently on the abdomen with the other hand to check the size and shape of the uterus and ovaries.

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HPV Screening

Who: Women who are sexually active need to be screened for HPV (human papillomavirus).

What: HPV spreads through vaginal, anal, or oral sex and is the most common sexually transmitted infection in the United States. The test looks for the virus, which can cause abnormal cells to grow on the cervix.

When: Women should get screened for HPV starting at age 30 and again every three to five years. This screening usually happens at the same time as the Pap smear (called co-testing). If the test is not performed, your doctor may request this screening after an abnormal Pap test result.

Why: In the majority of cases, HPV goes away on its own within two years; however, health problems that may develop include genital warts (found on the vagina, cervix, and/or skin) and cervical cancer.

Approximately 10,400 women were diagnosed with cervical cancer that was most likely caused by HPV between 2006 and 2010, according to the Centers for Disease Control and Prevention (CDC).

How: The screening process is exactly the same as a Pap smear.


Who: All women need to get mammograms.

What: Mammograms look at x-ray images of both breasts to check for any abnormalities (i.e. tumors) or changes (compared to previous mammogram results).

When: This is one of the more confusing screenings when it comes to recommendations. "The guideline I recommend — along with the American College of Obstetricians and Gynecology... is that women start having mammograms at age 40, and then annually every year after that," Triplett says.

But the American Cancer Society recommends starting annual screening at age 45 and then every other year after age 55; and the U.S. Preventive Services Task Force says the "benefits of mammography increase with age, with the greatest benefit for women between the ages of 50 and 74." So when and how often should you really get screened for breast cancer?

"My best advice is for women to talk with their health care provider to determine if they are a candidate for the routine screening or if they have any risk factors that would make them go outside of the guidelines," Triplett says.

Why: Mammogram screenings have been associated with a 15 to 20 percent relative reduction in death from breast cancer in women aged 40 to 74, according to the NCI.

That said, the NCI also reports that approximately 50 percent of U.S. women screened annually for 10 years will experience a false positive, and up to 54 percent of breast cancers detected by mammogram screenings are estimated to be results of overdiagnosis (diagnosing an issue that is highly unlikely to cause symptoms or death).

How: Your bare breast is briefly compressed between two plates on the mammogram machine. (The bottom plate contains x-ray film, which records the image that will be read by a radiologist.) The breast needs to be flattened in order to receive a high-quality picture. In most cases, two views of each breast are taken, but women with breast implants or large breasts may need additional images. While the entire screening takes about 20 minutes, the breast compression portion of the exam only lasts a few seconds.

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