For many women, gynecologists serve as specialist and primary care provider. As such, clinicians are given an opportunity to prevent and treat a wide variety of diseases. The incidence of these may vary greatly depending on the age group treated. Thus, the focus of medical questioning should reflect these changing risks. In addition to questioning regarding specific health complaints, a detailed history, including a thorough family history, can direct appropriate preventive screening.
Various organizations provide guidelines for preventive care and update their recommendations regularly. These include the Centers for Disease Control and Prevention (CDC), the U.S. Preventive Services Task Force (USPSTF), the American Cancer Society, and the American College of Obstetricians and Gynecologists.
The first reproductive health visit is recommended between the ages of 13 and 15 (American College of Obstetricians and Gynecologist, 2011). At this visit, rapport between an adolescent and her gynecologist can be established, the stage of adolescence assessed, and reproductive health care needs addressed. Whether periodic care continues with the gynecologist or with her pediatrician can be discussed at that visit. At this age, an internal pelvic examination is not performed in an asymptomatic adolescent unless otherwise indicated. Specific needs of the adolescent are presented in Chapter 14, and the American College of Obstetricians and Gynecologists offers additional information at their web site: http://www.acog.org/departments/dept_web.cfm?recno=7.
For adults, following historical inventory, a complete physical examination is completed. Many women present with complaints specific to the breast or pelvis. Their evaluation is described next.
Self breast examination (SBE) is an examination performed by the patient herself to detect abnormalities. Studies have shown SBE to increase rates of diagnostic testing for ultimately benign breast disease and to be ineffective in lowering breast cancer mortality rates (Kösters, 2008; Thomas, 2002). However, the American College of Obstetricians and Gynecologists (2011a), the American Cancer Society (2011a), and the National Comprehensive Cancer Network (Bevers, 2009) recommend breast self-awareness, which can include self-breast examination (American College of Obstetricians and Gynecologists, 2011a).
In contrast, clinical breast examination (CBE) is completed by a clinical health care professional and may identify a small portion of breast malignancies not detected with mammography. Additionally, CBE may identify cancer in young women, who are not typical candidates for mammography (McDonald, 2004). Clinical breast examination can be completed by various methods. However, in an attempt to standardize performance, a committee for the American Cancer Society has described a CBE that includes visual inspection combined with axillary and breast palpation, which is outlined next (Saslow, 2004).
Initially, the breasts should be viewed as a woman sits on the table's edge with hands placed at her hips and with pectoralis muscles flexed (Fig. 1-1). Alone, this position enhances asymmetry. Additional arm positions, such ...