Answering your questions about wellness exams for adults assigned female at birth – often called the “well woman exam”

Adults of reproductive age (18-45 years) who were assigned female at birth (i.e., born with a vulva and a vagina) frequently ask what screening examinations and tests are recommended for maintaining optimal health. Regular wellness visits are recommended for all adults to discuss reproductive life planning and to screen for common conditions like obesity, hypertension, depression, intimate partner violence, and substance abuse. However, physical examinations and diagnostic tests may be needed less often. (Additional recommendations for adolescents should be followed as indicated.)

Dr. Carrie Cwiak, Professor of Gynecology and Obstetrics at Emory University, offers the following answers to frequently asked questions:

Questions

How often should I have cervical cancer screening?

Cervical cancer screening is most commonly performed with a Pap test, which tests if the cells on your cervix show any signs of precancerous changes. This test is first done when you turn 21 years of age. After a normal result, a Pap test should be repeated every 3 years. If you have an abnormal result, you may need a repeat Pap test in 1 year or a test called a colposcopy (an examination that looks at your cervix with a microscope to look for abnormal cells and to determine if a biopsy needs to be taken).

Starting when you reach age 25, a human papillomavirus (HPV) test is often added to abnormal Pap tests to determine if a colposcopy is needed. Starting when you reach age 30, co-testing (Pap and HPV testing) is recommended. If both Pap and HPV test results are negative, then co-testing should be repeated every 5 years.

Future screening recommendations will include the option for HPV testing as a stand-alone test without requiring a Pap test.

How often should I be tested for sexually transmitted infections?

Every adult should have a blood test for human immunodeficiency virus (HIV) and hepatitis C at least once in their lifetime.

Testing for chlamydia and gonorrhea is recommended annually until you are age 25 and then regularly whenever you have a new partner, or if your partner may have a new partner, or if you have symptoms suggestive of infection. This can be done with a self-swab, blind swab (i.e., no speculum used), or a pelvic examination using a speculum.

Testing for syphilis (blood test) and trichomonas (swab) are recommended for people with suggestive symptoms and in areas that have a high incidence of those infections. People unvaccinated for hepatitis B should have testing for infection and receive a vaccination if found to not be immune.

How often should I have a pelvic examination?

A pelvic examination should be done whenever you have questions about your genital development or concerning symptoms (e.g., lesions, itching, odor, discharge, pain, abnormal bleeding). It is performed when a provider places a speculum in your vagina to see your vagina and cervix, and/or places their fingers in your vagina to feel your cervix, uterus, and ovaries. If testing for infection, pap, or HPV is also needed, they can complete this at the same time. A Pap test or other test for infection is not always performed during a pelvic examination – patients should ask their provider what testing is done if they undergo a pelvic examination.

How often should I have a breast examination?

A breast examination should be done whenever you have questions about your breast development or concerning symptoms (nipple discharge, skin changes, pain, or a persistent mass). For people who have a personal or family history of a BRCA mutation, annual breast examinations should begin at age 25. Otherwise, breast examination may be done every 1-3 years, beginning when you reach age 25.

Depending on the health organization, a mammogram is recommended either every 1 or 2 years beginning when you reach age 40. Since a mammogram is currently the best method of screening for breast cancer, it is reasonable to have a screening mammogram and breast examination beginning when you reach age 40.

Are there other blood tests that are recommended?

If you have concerning symptoms, a positive family history, or other risk factors for anemia (e.g. heavy menstrual bleeding), thyroid disease (irregular menstrual bleeding), diabetes (obesity), or elevated cholesterol (obesity), regular blood testing is recommended.

What vaccinations are recommended?

If you have received all recommended vaccines in childhood, then there are fewer vaccines you will need as an adult:

• HPV vaccination is recommended for all people of any gender to prevent HPV-related diseases like genital warts, cervical cancer, anal cancer, and throat cancer. It can be given to children as early as age 9. If you receive your first dose before age 15, then you only need one more dose 6 months later. Otherwise, a total of 3 doses is needed: at day 1, at 1-2 months, and at 6 months. A booster dose is not needed.
• Influenza vaccinations are recommended annually during influenza season (fall to winter).

Are there other cancer screening tests recommended?

Screening for colon cancer by colonoscopy is recommended starting when adults reach age 45. People at higher risk for colon cancer (due to family history, etc.) may need to begin screening at an earlier age.

Additional screening tests may be recommended for patients with suggestive symptoms or risk factors for particular conditions.

---

Reference

2024 Recommendations for Women’s Preventive Health Care. Women’s Preventive Services Initiative (WPSI). ACOG Foundation. 2024. Supported by: American Academy of Family Physicians, American College of Obstetricians and Gynecologists (ACOG), American Academy of Physicians, and the National Association of Nurse Practitioners in Women’s Health.