Paula J. Adams Hillard
Preventive health services that encompass screening and counseling for a broad range of health behaviors and risks are important components of general obstetric and gynecologic care.
Traditional gynecologic care—including cervical cytology testing, pelvic and breast screening examinations, and the provision of contraceptive services—is considered primary preventive care.
Routine health care assessments for healthy women include a medical history, physical examination, routine and indicated laboratory studies, assessment and counseling regarding healthy behaviors, and relevant interventions, taking into account the leading causes of morbidity and mortality within different age groups.
Evidence-based guidelines for the provision of periodic health evaluations, screening, and counseling have been developed by the American College of Obstetricians and Gynecologists (ACOG) and other organizations; these guidelines provide the basis for routine preventive health assessment and screening recommendations.
Preventive services for adolescents should be based on knowledge of the behavioral and medical health risks that place their future health at risk, including substance use and abuse, sexual behaviors that increase the risks of unintended pregnancy and sexually transmitted diseases (STDs), and impaired mental health.
Obesity, smoking, and alcohol abuse are preventable problems that have a major impact on long-term health; assessment, counseling, and referral for these health risks is a component of periodic health assessment and primary care.
Although obstetricians-gynecologists have focused on the management of abnormal gynecologic conditions, they also have a traditional role of providing primary and preventive care to women, particularly for women of reproductive age. The obstetrician-gynecologist often serves as a woman’s point of entry into the health care system, her primary care clinician, and a source of continuity of care (1). Primary care emphasizes health maintenance, preventive services, early detection of disease, and availability and continuity of care. The value of preventive services is apparent in such trends as the reduced mortality rate from cervical cancer that resulted, in large part, from the increased use of cervical cytology testing. Neonatal screening for phenylketonuria (PKU) and hypothyroidism are examples of effective mechanisms for prevention of mental retardation. Women often regard their gynecologist as their primary care provider; indeed, many women of reproductive age have no other physician. Obstetricians-gynecologists estimated that at least a third of their nonpregnant patients rely on them for primary care (2). As primary care physicians, obstetricians-gynecologists provide ongoing care for women through all stages of their lives—from reproductive age to postmenopause. In this role, some gynecologists include as a routine part of their practices screening for certain medical conditions, such as hypertension, diabetes mellitus, and thyroid disease, and management of those conditions in the absence of complications.
Some traditional aspects of gynecologic practice, such as family planning and preconception counseling, are recognized as effective preventive health measures, although clear and coherent national guidelines and goals for preventing unintended pregnancies have not been a high priority in the United States (3). Preventive medical services encompass screening and counseling for a broad range of health behaviors and risks, including sexual practices; prevention of sexually transmitted diseases (STDs); use of tobacco, alcohol, and other drugs; diet; and exercise.