NEW YORK -- Annual gynecological exams should include screening for hepatitis, diabetes, HIV, and urinary and fecal incontinence, according to The American College of Obstetricians and Gynecologists (ACOG).
"Periodic assessments provide an excellent opportunity to counsel patients
about preventive care," according to an ACOG report.
ACOG provides recommendations on what types of screening, evaluation, and
counseling should be included in women's routine exams, based on patients' age
and risk factors. The College's new recommendations, released this week, replace
those issued in 1997.
The new recommendations include a fasting glucose test for diabetes every
3 years for all women over 45, instead of just those at risk for the disease.
Because African-American, Hispanic, and Native American women are more likely to
develop diabetes, they have been included in the high-risk definition.
A major recommendation is that all women at risk for infection with the
hepatitis A and C viruses be tested regularly. This group of women includes
those who received organ transplants or blood transfusions before 1992, and
those with a history of injectable drug use. In addition, those who are
traveling out of the country, who inject illegal drugs, or who work in the food
service, healthcare, or day care industries, should be vaccinated against
hepatitis A.
A commentary in the December issue of Obstetrics & Gynecology notes that
most women with hepatitis C do not know they are infected, and can pass the
virus to their infants. Hepatitis C can lead to cirrhosis, liver failure, liver
cancer, and death.
Another major change is ACOG's recommendation that women should be tested
for HIV during preconception care, not just after they get pregnant.
For sexually active teens and those at high risk for sexually transmitted
disease, the College recommends routine screening for gonorrhea and chlamydia.
In addition, all women with invasive cervical cancer should be considered at
high risk for HIV, and should be tested.
ACOG experts also recommend that doctors ask all patients about their use
of complementary and alternative medicines in order to develop a more complete
medical record and to encourage safe use of these products.
The College's recommendations still include an annual pelvic exam and Pap
smear, beginning at age 18 or when sexually active; mammography every year or
two for women in their 40s, changing to every year starting at age 50; and a
first preventive care visit to an OB-GYN at age 13 to 15, which does not have to
include a pelvic exam or Pap smear.
