Gynecological health examination items

Routine gynecological examination, routine leucorrhea, cervical cancer screening (TCT+HPV), pelvic ultrasound, six items including abnormal menstruation or pregnancy preparation, menopausal needs plus sex hormones. Most of the other additional items can be selected on demand. There is no need to blindly pursue a high-priced "full package".

Don't tell me, I actually met such a 22-year-old girl in the outpatient clinic last week. She just saved 3,000 yuan from work. She said she wanted to have the most expensive "gynecological high-end physical examination" on the market. She was afraid that she had some hidden problems. I checked her past history and found that she had no family history. She had been sexually active for one year. She had regular menstruation and no abdominal pain or abnormal leucorrhea. In the end, the total number of items prescribed for her was only over 800. The girl was stunned for a long time when she got the bill, thinking that I was perfunctory. In fact, this is not the case. Many of the fancy items packaged by physical examination institutions are essentially IQ taxes.

Let’s first talk about cervical cancer screening, which everyone is most concerned about. This is also the most controversial item at present. According to the guidelines of American ACOG, TCT (liquid-based thin-layer cytology test) should be started regardless of whether one is sexually active or not after the age of 21, and combined with HPV screening after the age of 30. ； However, the guidelines of the National Maternal and Child Health Association are more in line with the domestic situation. It is recommended that women who have been sexually active for three years or over 21 years old are enough to start screening. Even if they are sexually active, women under 21 years old are not recommended to be screened. After all, most HPV infections in this age group are transient and can turn negative on their own in 1-2 years. If detected, it will only increase anxiety. Many people also ask whether taking the nine-valent vaccine does not require testing? At present, there is no unified conclusion in the industry: Conservative doctors believe that routine screening should be carried out no matter how much the price is. There are also research data showing that for low-risk groups who are fully vaccinated and have two consecutive joint screening results that are all negative, the screening interval can be extended to 5-10 years. You can choose according to your own acceptance.

When it comes to the accuracy of screening, we have to mention the question of which pelvic ultrasound to choose that many people are confused about. I have seen too many sexually active girls insisting on transabdominal ultrasound every time. They were sweating profusely while waiting in line. As a result, they could not see their appendages due to obstruction of intestinal gas. In the end, they still had to do a vaginal ultrasound, which was a double mistake. It is true that many people have concerns about vaginal ultrasound, thinking that it is "not clean when inserted into the body" and "will hurt." However, vaginal ultrasound probes in regular hospitals are covered with disposable sterile sleeves, so there is no risk of cross-infection, and there is no need to hold in urine. The identification of endometrial polyps, small fibroids, and ovarian cysts is at least 30% higher than transabdominal ultrasound. Except for women who are not sexually active and need to choose transabdominal or transrectal ultrasound, the rest of the people can really choose vaginal ultrasound first, and there will be basically no obvious pain when you relax.

Oh, by the way, there is also the tumor marker CA125 that many people ask about. Don’t listen to the institutions that say it must be done every year. It is really not necessary for ordinary healthy people. I met a 30-year-old girl a while ago. Her CA125 level was twice as high as the normal value during a physical examination at work. She cried at home for three days and thought she had ovarian cancer. When she came over for a checkup, she found that it was a physiological increase before menstruation. She shed so many tears in vain. This item itself has high sensitivity and low specificity. Menstruation, pregnancy, and even common pelvic inflammatory disease may cause the value to rise. Only high-risk groups with a family history of ovarian cancer and BRCA gene mutations need to add this item to their physical examination list regularly.

Needless to say, routine leucorrhea, a general physical examination is enough. If there are no problems such as repeated itching, odor and yellow leucorrhea, there is no need to spend more money for a more expensive vaginal microecological test. Just be careful not to have sex, do not irrigate the vagina, and do not insert medicine 24 hours before the test, otherwise the test results will be inaccurate and the reference will be of little significance. As for the six items of sex hormones, they are not something that everyone needs to check: Young girls with regular menstruation and no need to prepare for pregnancy do not need to check every year. If you have irregular menstruation, abnormal acne, have not been pregnant for more than six months, or have hot flashes and night sweats during menopause, you can check again. Remember to check on an empty stomach in the morning on the 2nd to 4th day of menstruation. Don’t wait until menstruation is clear before going again. The hormone levels detected are simply useless.

I have been practicing clinical gynecology for almost 10 years, and I have seen too many people who spent thousands of dollars on physical examinations, only to find out what should be checked, and what should not be found, and a lot of abnormalities were found that scared them to death. I really want to say that when it comes to gynecological examinations, it is more important to be suitable than to be expensive. There is no need to cram in a bunch of useless items for the so-called "comprehensive". Before going, you should check your physical condition and find a reliable doctor to ask a few questions. It is much better than blindly pondering online strategies. Don't panic if you find a small problem. Most of them can be solved by early intervention, so don't scare yourself.