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Gynecological health screening: which tests, how often?

Gynecological health screening has been proven to prevent certain cancers and other serious diseases. Women should adhere to recommended screening programs. Often questions arise about when to commence screening, frequency of screening visits, what to be screened for and when to stop.

Predisposition to Gynecological diseases depends on reproductive age. Just after onset of puberty and prior to sexual activity, the risks of Gynecological diseases are very low. Most screening programs commence shortly after starting sexual activity, or between the ages of 21 – 25 years.

An annual pelvic assessment may be combined with annual general health screening for other conditions. This is usually an opportunity to discuss general Gynecological health, and review any symptoms that may warrant further interrogation. An internal examination is not always mandatory.

Young women, below the age of 25 and with multiple sexual partners, should be screened for sexually transmitted infections including HIV. This also applies to older women with new or multiple sexual partners. Sexual infections have undesired fertility consequences, and prevention and prompt treatment is paramount.

Pap smear tests screen for changes that may lead to cervical cancer. This may be coupled with Human Papilloma Virus (HPV) testing. Testing should begin about 3 years after starting sexual activity, and no earlier than 21 years. Between the ages of 9 – 26 years, HPV vaccine may be offered to women who have not been exposed to HPV, but Pap smear screening should continue. The interval of Pap smears depends on individual risk factors, but studies have a shown that an interval of 3 years is safe for those who have had previous negative results and no new symptoms or risk factors. Women with concurrent diseases like HIV should be tested more frequently. After the age of 65, the risk of cervical cancer is very low if previous Pap smears have been negative, hence women in this age group could stop testing.

All women should learn how to do self-breast examination, and if any abnormal changes are detected, seek advice immediately. Mammography imaging to screen for breast cancer is recommended from 40 years, and only earlier if additional risk factors (like family history of early onset of breast cancer) are present. Testing should be done every 1 – 2 years.

Some diseases, like ovarian cancer, do not yet have a recommended routine screening test. Annual blood tests and ultrasound scans may lead to unwarranted interventions. Some women may however benefit from such surveillance, depending on personal and family medical risk profiles.

The medical industry is rife with fancy screening tests that have little scientific basis. An example is full body scans, searching for non-existent but potential future diseases in healthy individuals! Such tests often lead to undue anxiety and unnecessary interventions, and are not recommended

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