What diagnostics are typically included in a common gynecological check-up?

Common Gynecological Check-Up Diagnostics

A routine gynecological check-up should include cervical cancer screening (Pap smear with or without HPV testing depending on age), STI screening based on risk factors, vital signs, BMI measurement, and comprehensive history-taking—but routine pelvic examination for screening asymptomatic conditions beyond these specific tests is not supported by evidence. 1

Core Screening Components with Strong Evidence

Cervical Cancer Screening

• Women aged 21-29 years: Cervical cytology (Pap smear) every 3 years 1, 2
• Women aged 30-65 years: Either cytology every 3 years, HPV testing alone every 5 years, or co-testing (cytology + HPV) every 5 years 1, 2
• Do not screen women under age 21, regardless of sexual activity 3, 2
• Discontinue screening after age 65 with adequate prior negative screening (three consecutive normal tests in past 10 years) 3, 2
• Do not screen women post-hysterectomy unless history of high-grade cervical lesions or cancer 3, 2

STI Screening

• Screen sexually active women aged 24 years and younger for chlamydia and gonorrhea 1
• Screen older women at increased risk for infection 1
• Use urine samples or self-collected vaginal swabs—pelvic examination is NOT required 1, 3

Essential History and Physical Components

Comprehensive Medical Assessment

• Document chronic conditions, medications, allergies, family history, and detailed menstrual history 3
• Measure height, weight, calculate BMI, and blood pressure 3
• Screen for depression, anxiety, intimate partner violence, and major life stressors 3
• Assess tobacco, alcohol, and drug use 3

Reproductive Planning Discussion

• Discuss contraceptive needs, pregnancy intentions, and birth spacing at every visit 3
• Provide contraception counseling including emergency contraception options 3
• Recommend folic acid supplementation for all women of reproductive age 3

The Pelvic Examination Controversy: What the Evidence Shows

The routine screening pelvic examination (external genitalia inspection, speculum exam, bimanual palpation) for asymptomatic women has insufficient evidence to support its use for detecting conditions other than those requiring specific tests (cervical cancer, STIs). 1

Key Evidence Limitations

• No studies demonstrate that screening pelvic examination reduces morbidity or mortality from any gynecologic condition 1
• Positive predictive value for ovarian cancer detection is less than 4% 1
• False-positive rates for ovarian cancer range from 1.2% to 8.6%, leading to unnecessary surgery in 5-36% of women with abnormal findings 1

Documented Harms

• Pain or discomfort reported by 11-60% of women (median 35%) 1
• Fear, embarrassment, or anxiety reported by 10-80% of women (median 34%) 1
• May cause women to avoid or postpone healthcare visits 1

When Pelvic Examination IS Indicated

• Perform when indicated by medical history or symptoms 4
• Required for obtaining cervical cytology specimens 1
• Women with current or history of cervical dysplasia, gynecologic malignancy, or in utero DES exposure require examination per condition-specific guidelines 4

Special Considerations for Adolescents

• External genital examination should be part of routine annual physical at all ages 3
• Do NOT perform pelvic examination on asymptomatic adolescents—STI screening uses urine or self-collected swabs 3
• Provide confidential discussions about sexuality, sexual orientation, gender identity, and contraception 3
• Gynecologic care should begin when clinically indicated, not based solely on screening needs 3

Additional Preventive Counseling

• Review and update immunizations according to current recommendations 3
• Provide lifestyle counseling on nutrition, physical activity, sleep, and tobacco cessation 3
• Counsel women with BMI ≥30 or <18.5 kg/m² regarding fertility and pregnancy risks 3

Critical Clinical Pitfall

Many women erroneously believe a pelvic examination equals a Pap test—they may report having had cervical screening when only a pelvic examination was performed. 1 Always clarify whether actual cervical cytology was obtained and documented, as self-reports are often inaccurate. 1