Gynecological health examination

Gynecological health examination is not an exclusive item for married women with children. As long as they have had sexual intercourse (including borderline sexual intercourse), it is recommended to have a basic screening once a year. Women who have not had sexual intercourse can have a basic examination every 2-3 years if they have no abnormal symptoms. This is currently recognized in the field of obstetrics and gynecology as the most cost-effective way to prevent malignant gynecological diseases and common diseases.

We just received a 22-year-old girl from the outpatient clinic last week. She had just worked for half a year. The welfare physical examination at her workplace did not include gynecological items. She thought that her leucorrhea was a little yellow recently, so she spent an extra 180 yuan to get a TCT screening. The result was that she was a high-grade squamous intraepithelial lesion, which is a precancerous lesion of the cervix. Fortunately, it was discovered early and was solved by a small outpatient conization. If it had been delayed for another two or three years, it would have probably developed into invasive cervical cancer, and subsequent treatment would have been much more troublesome.

When it comes to this, some people will definitely say, I’m not married yet, and I’m not uncomfortable, so why do I do this? There are actually two clinical opinions on this point: Conservative doctors will recommend that women who have no sexual intercourse, no abnormal menstruation, and unexplained abdominal pain do not need to go for gynecological examinations to avoid invasive procedures that damage the hymen; but the view of the evidence-based medicine school is that many ovarian cysts and polycystic ovary syndrome have no obvious symptoms in the early stages. Even if they have no sexual life, they can be screened through non-invasive methods such as transabdominal ultrasound and anal ultrasound, which will not cause damage and can detect problems early. My own habit is to ask the girls who come for consultation about the situation first. If they have regular menstruation and are not uncomfortable, there is really no need to make a special trip. However, if menstruation only comes once every two or three months, or if you have lower abdominal pain every now and then, even if you have not had sex, it is recommended to have an ultrasound to reassure you.

Many people are most likely to be deceived when going for a gynecological examination. As soon as they enter a private institution, they are sold "ovarian anti-failure screening" and "a full set of in-depth gynecological examinations" worth thousands of dollars. It is really unnecessary. The basic package I usually prescribe for relatives and friends at home only requires three things: first, a routine gynecological examination, which is only done if you are sexually active, to see if there are any visible abnormalities in the vulva, vagina, and cervix; second, cervical screening, which is what everyone often hears about TCT+HPV. There is actually no need to do this together before the age of 30. To check, TCT alone is enough every 3 years. After the age of 30, it is recommended to do two tests together. Once every 5 years is enough. You don’t have to listen to the agency to do it every year, which is a waste of money. The third is gynecological ultrasound, which can be done regardless of whether you have sex or not. It can check whether there are cysts, fibroids and other abnormalities in the uterus and ovaries. The total cost of these three items in a public hospital is only 300 to 400 yuan. It can screen out more than 90% of common gynecological problems, which is really enough.

Let’s talk about a small detail that many people don’t know. In order to avoid embarrassment, many girls use lotion to clean their vaginas before a physical examination. They even abstain from sex the day before. In fact, it doesn’t need to be so “clean”. Douching the vagina will flush out abnormal secretions and exfoliated cells. The results of leucorrhea and TCT tests will be inaccurate. The day before, just wipe the vulva with warm water and don’t have sex. Don’t insert drugs. There are also many people who reject vaginal ultrasound because they think it is dirty or embarrassing. In fact, the probe of vaginal ultrasound is put on a new sterile condom every time, so there is no cross-infection at all. It is much clearer than transabdominal ultrasound, and you don’t have to hold urine for a long time. You will know how delicious it is after you try it once. Oh, by the way, not all items need to be avoided during the menstrual period. If the six hormones and ovarian reserve function are checked, it is most accurate to check on the 2nd to 3rd day of menstruation.

The most controversial issue regarding gynecological physical examinations is whether or not cervical cancer screening should be done after receiving the HPV vaccine. Some popular science accounts will make it clear that screening should be carried out as usual regardless of the price. The latest clinical research shows that if you have been fully vaccinated with the nine-valent HPV vaccine and the results of two consecutive joint screenings are negative, the screening interval can be extended to once every 10 years. At present, there are no updated relevant guidelines in China. My suggestion is that if you are worried about trouble, you can bring your vaccination records and previous screening reports to a doctor for evaluation. If you are on the safe side, check at the original frequency. After all, it is not a loss to spend a few hundred yuan more to buy one with peace of mind.

I have been practicing obstetrics and gynecology for 11 years, and I have seen too many girls put off the gynecological examination because they find it embarrassing and embarrassing. They wait until intercourse bleeding and abdominal pain are unbearable before coming. At that time, small problems turn into big problems and they suffer more. In fact, there is really nothing special about gynecological examination. It is just an ordinary health examination, just like your annual vision check and blood pressure check. Don’t think of it as too scary, and don’t think of it as a label “exclusively for married women”. After all, your body is your own, and it is better to detect problems early than late, right?