What are the items in gynecological health examination?

There is no cookie-cutter fixed list for gynecological health examinations. The core items are mainly set around the three dimensions of reproductive tract appearance, function, and risk of lesions. The actual billing will be flexibly adjusted based on age, sexual history, past medical history, and current demands. There is no need to blindly pursue "all items."

A few days ago, a 22-year-old girl came to me to order a physical examination. She said that she had read online that there were more than a dozen items required and it would cost less than 2,000. When I asked her, she had only had sexual intercourse for half a year and had no problems with abnormal leucorrhea or abdominal pain. In the end, I only ordered a basic physical examination, routine leucorrhea, TCT+HPV joint screening, and an abdominal ultrasound. The total cost was only more than 400, which was completely enough.

It is a gynecological examination that everyone is a little scared of. To put it bluntly, the doctor first looks at the vulva with the naked eye to see if there are any vegetations or skin abnormalities, and then uses a speculum to check the condition of the vaginal wall and cervix to see if there are polyps or abnormal vegetations. The "cervical erosion" that everyone often hears is no longer a disease, but a physiological phenomenon of cervical columnar epithelial ectopia. Don't panic after seeing the results. After that, the doctor will use bimanual examination to feel the position and size of the uterus and bilateral appendages to see if there is tenderness or abnormal masses. Girls who have not had sexual intercourse can do an anal examination, which will not damage the hymen, so there is no need to worry about this. Oh, yes, there is a rather controversial saying now: "If you don't have sex, you don't need to have a gynecological examination at all." This is actually not true. If you have long-term menstrual irregularities, lower abdominal pain and lumps, you still need to have an anal examination to check for problems even if you don't have sex. You can't just carry it on.

The accuracy of naked eye and hand touch is limited. To troubleshoot more subtle problems, laboratory examinations must be combined. For example, routine leucorrhea testing is the most commonly used. If your leucorrhea has recently turned yellow or green, has a peculiar smell, or is itchy on the vulva, this project must be done. It can quickly detect whether there is mold, bacteria, or trichomoniasis infection. The results cost only a dozen yuan, and you can prescribe appropriate medicines and you will be cured quickly. Everyone has heard most about TCT and HPV for cervical cancer screening. It is recommended to have both tests together after having sex for those over 25 years old. If the results are negative two or three times in a row, the test can be done every 3-5 years instead of every year. I once met a 32-year-old woman who had double vaginal discharge every year for 4 consecutive years. It was a waste of money. There are also six items of sex hormones that people often ask about. This should only be done when you have menstrual disorders, abnormal bleeding, suspected polycystic cysts, or when you need to evaluate ovulation in preparation for pregnancy. There is no need to add routine physical examinations, and it must be checked on the 2-3rd day of menstruation to be most accurate. Don’t go there in vain.

To check the status of the organs deep in the pelvic cavity, you have to rely on imaging examinations. The most commonly used is gynecological ultrasound, which is divided into abdominal ultrasound and transvaginal ultrasound. If you are sexually active, vaginal ultrasound is preferred. You don’t have to hold in your urine and you can see more clearly. If you are not sexually active, you can choose abdominal ultrasound. Just hold in your urine. Ultrasound can clearly see the size of the uterus, whether there are fibroids and adenomyosis, whether the thickness of the endometrium is normal, whether there are cysts or polycystic changes in the ovaries, and it can also monitor ovulation. A routine annual physical examination is enough. As for the "high-end screening" of CT and hysteroscopy promoted by many institutions, routine physical examinations are completely unnecessary. Only if abnormal masses or unexplained abnormal bleeding are detected by ultrasound, further invasive or radiation-related examinations are needed. Don't be fooled by marketing tricks.

If you are a perimenopausal woman over 45 years old, or have a family history of ovarian cancer or cervical cancer, in addition to the basic items, you can add items such as tumor marker blood drawing and endometrial screening, which are more targeted and can detect risks earlier.