by Christine Haran

For most women, the physician they are most likely to see on a regular basis is their gynecologist. Women visit their gynecologist's office for birth control, STD testing and any number of other health matters, from vaginal infections to menstrual cramps.

The American College of Obstetricians and Gynecologists (ACOG) recommends annual check-ups, starting with a visit between ages 13 and 15. Most women will continue to see a gynecologist or other reproductive health care provider, such as a midwife, throughout their lives. So how can you maximize your yearly visit with the gynecologist? Suzanne Merrill-Nach, MD, a gynecologist in private practice in San Diego, Calif. and ACOG spokesperson, offers some expert advice about maintaining your reproductive health.

What tests are done in the routine visit?

The Pap smear is done annually in women over 21 or younger women who are sexually active. The Pap can be deferred to once every three years in women over 30 if you are at low risk and you've had three normal Pap smears. If you had genital warts, have multiple sexual partners, or have had multiple partners in the past, or are a smoker that puts you at higher risk of developing cancer of the cervix, that means you should continue to do yearly Pap smears. But we still do the yearly checkup whether or not you're getting a Pap smear to make sure everything looks OK, because we're checking other things such as the breasts, ovaries and menstrual cycles.

On a breast exam, we're looking for any changes in the skin, any nipple discharge, and any lumps or bumps that seem different. For the pelvic exam, we check the vagina for signs of infection, which is discharge or redness. On the cervix, we look for any changes on the outer part of the cervix, any white areas, any bumps. We try to assess the size and the overall shape of the uterus and we make sure that the ovaries aren't enlarged.

Many gynecologists also do basic preventative care for women. We do blood pressure screening, diabetes screening, cholesterol screening, and even check vaccinations such as tetanus shots.

How do you know if a STD screening should be performed?

It's important to tell the person doing your exam if there's been a change in your sexual relationship. Typically, a STD screening should be done yearly in women up to 26. After that, we should do them ideally before you have a new partner, and the new partner should also be tested. If you've changed partners or you have other high-risk behaviors, then an AIDS test should be offered.

If you know your partner has multiple partners or suspect it, you're still at risk, even if you haven't had other partners, so you should be tested for STDs. It's also good to let your gynecologist know if your partner has genital warts or herpes, even if you don't have any evidence of these illnesses.

What about your health history is important to share?

At each visit it is important to go over your family history, your personal history, how your health has been over the past year, your family history in regard to cancers, diabetes and heart disease. If you have a family history of premenopausal breast cancer or breast cancer in multiple family members, you should tell your provider. We recommend mammograms beginning at age 40 if you have no family history of early cancer.

If you have a family history of ovarian cancer, women might be able to decrease their risks by being on birth control pills even if they don't need them for birth control. Unfortunately, we don't have any good tests for ovarian cancer at this time.

What other kinds of information does your reproductive healthcare provider want to know?

We would want to know about your menstrual cycle. Period flow varies tremendously from woman to woman. A normal menstrual cycle is between 21 to 35 days intervals, and they should last less than seven days. If you're having such heavy periods that you're soaking through pads or tampons in two or three hours, that would probably need to be evaluated.

You should tell your provider about any discharge that seems different than what you're used to, especially with itching or irritation or burning or odor. Many women who have had recurrent or prior yeast infections who are having similar recurrent type symptoms can use the over-the-counter medicines. But if you're not sure, or if you haven't had them before, it's better to be examined.

If your menstrual cramps are not easily treated with over-the-counter medicines, or if you're all of a sudden having problems or cramps that are getting worse, that should be evaluated. You should also mention if mood symptoms are bothersome or if they interfere with your relationships and your ability to function at work or with family and friends.

Most women experience bladder infections, which is the fairly sudden onset of having to pee all the time, pain or pressure with urination or at the end of urination, blood in your urine, backache and fever. We would want to talk about urinary tract symptoms during the visit.

Is it appropriate to discuss depression with your reproductive health care provider?

Some gynecologists will do more primary care than others. But, it's always OK to discuss it, and if the doctor or provider isn't comfortable with treating things outside the GYN field, they can always refer. But it's good to bring it up, and doctors need to know other issues that are going on in your health.