What are the items in gynecological health examination?

The core items of routine gynecological health examinations are not complicated. I have been in outpatient clinics for almost 8 years, and I have seen too many girls who clamor for "the most expensive package of all items" right from the start. In fact, it is really unnecessary. The selected items must be based on age, sexual life history, physical symptoms and past medical history, as long as it is practical enough.

Last week, I met a 23-year-old girl who had just been sexually active for half a year. Before the physical examination, she read a lot of popular science about cervical cancer. She was so scared that she had to order all HPV subtypes, pelvic CT, and a full set of tumor markers as soon as she came in. I stopped her. She usually does not experience intercourse bleeding, abdominal pain or abnormal leucorrhea, so it is enough to do the basics first.

The most basic is a gynecological examination. You lie down on the examination bed and first visually examine the vulva, vagina, and cervix, and then do a bimanual examination to find out the position, size, and tenderness of the uterus and appendages. Don’t think this project is embarrassing and “primitive”. Many abnormal signals of cervical polyps, vaginal wall cysts, and pelvic inflammatory disease can be detected by the doctor’s touch + naked eye, which is more direct than instrument screening. You can take a leucorrhea sample during the physical examination. Regular leucorrhea plus BV testing can be used to check for mold, trichomoniasis, bacterial vaginosis and vaginal flora imbalance for only a dozen yuan. It is much more reliable than guessing at home and using lotion. If you have yellow and smelly leucorrhea or vulva itching, you can just add a Mycoplasma and Chlamydia test to check for the possibility of sexually transmitted infections.

Women who have had sexual intercourse must arrange for cervical cancer screening no matter how old they are. I met a 26-year-old girl before who had occasional bleeding in the same room for almost half a year. She thought it was bleeding during ovulation. After a TCT test, it was found to be a high-grade squamous intraepithelial lesion. Fortunately, it was discovered early and a small conization was performed to solve the problem and it did not develop into cancer. The current general recommendation in the industry is that TCT alone is enough before the age of 30, and checked once every three years. After the age of 30, it is recommended to conduct combined TCT and high-risk HPV screening, once every five years. It does not need to be done every year. Over-screening can easily cause unnecessary anxiety.

Deep organs such as the uterus and ovaries in the pelvic cavity must be diagnosed by gynecological ultrasound. Those who have had sexual intercourse are preferred to choose transvaginal ultrasonography. They do not need to hold in urine, and the imaging is clearer. Problems such as uterine fibroids, ovarian cysts, polycystic ovaries, and endometrial abnormalities can be found. Girls who have not had sexual intercourse choose transabdominal ultrasound, and they only need to hold in urine in advance. If you have perennial dysmenorrhea or abnormally increased menstrual flow, you can take a CA125 test to check for the possibility of endometriosis.

If you usually have irregular menstruation and no news about pregnancy preparation for a long time, you can also add six sex hormone tests. It is best to draw blood on an empty stomach in the morning on the 2nd to 3rd day of menstruation, which can directly reflect ovarian function and endocrine status. Nowadays, many routine gynecological examination packages also include breast examination. Don’t take it seriously because the breast does not belong to gynecology. Breast ultrasound is preferred for those under 35 years old, and mammography can be added for those over 35 years old. The detection rate of breast nodules in young women is really high now.

As for the dozens of HPV subtype tests, a full set of gynecological tumor markers, and gynecological disease susceptibility gene tests recommended by many institutions, there are indeed different views in the industry. One group believes that more comprehensive tests can detect risks in advance, while the other group believes that many low-risk HP Even if V subtype is tested positive, there are no targeted intervention methods. Instead, it will bring unnecessary psychological burden to the subjects. If you do not have high-risk factors such as multiple sexual partners and long-term low immunity, in fact, routine high-risk HPV screening is enough without spending extra money.

The 23-year-old girl I mentioned just now only had a basic physical examination, routine leucorrhea, TCT and transvaginal ultrasound, which totaled only more than 300 yuan. All the results were normal, and she left happily. Really, the more expensive the better for gynecological health examinations. The most useful ones are those that match your actual situation.