Your reproductive and sexual health care checklist for your 20s

Everyone’s different, but for many people their 20s is a time of self-discovery—living on your own for the first time, kicking off your career, exploring new relationships, and even just figuring out your sexual interests, desires, and needs. 

With that comes new reproductive and sexual health issues to be aware of. 

We reviewed the clinical guidelines and recommendations for people with vaginas in their 20s so you know what’s on the docket this decade. Since recommendations may vary based on your health status and medical history, it’s always a good idea to talk to your health care provider about what’s right for you.

What reproductive and sexual health screenings should you get in your 20s?

When it comes to reproductive and sexual health, you might be wondering: What medical tests do I need in my 20s? We’re here to help. Here’s an overview of what screenings and tests you can expect.

Cervical cancer screening

The United States Preventive Services Taskforce recommends that people with cervixes who are in their 20s get cervical cancer screenings at a frequency based on their age. Screenings for people in their 20s include Pap tests.

Pap tests (often called Pap smears) involve the collection of cervical cells to check for precancerous and cancerous cells caused by the human papillomavirus (HPV). Follow-up testing may be needed.

HPV testing checks for strains of HPV that are associated with cervical cancer.

These are the recommendations for cervical cancer screening for people in their 20s:

• People with cervixes should get their first Pap test at 21 — even if you’re not having sex.
• People with cervixes should continue getting Paps every three years if they are normal (more frequently if there are abnormal cells).

More frequent screening may be recommended based on your unique health history

The American Cancer Society also recommends starting HPV testing at age 25 and repeating it every five years until age 65. 

If you’ve had your uterus and cervix surgically removed (aka total hysterectomy) for reasons unrelated to cervical cancer, you don’t need Pap tests. If you had a total hysterectomy because of cervical cancer or precancer, your health care provider will recommend the best follow-up care for you.

Learn what you can expect from a Pap and HPV test.

Screening for sexually transmitted infections (STIs)

Sexually transmitted infections (STIs) are extremely common and highly treatable. However, if left untreated, they can lead to issues like pelvic inflammatory disease (PID), infertility, and pregnancy complications.

The following STI tests are recommended for people with vaginas in (and beyond) their 20s:

• Anyone ages 13-64 should get an human immunodeficiency virus (HIV) test at least once.
• People who are sexually active and under the age of 25 should be screened annually for gonorrhea and chlamydia, or if they have a new partner. It is important to tell your healthcare provider where you have sex, because STIs can live in your throat, vagina, penis, or anus—and all of those sites can be tested.
• After age 25, people should continue to get tested for gonorrhea and chlamydia annually when they have new or multiple sex partners — or if their sex partner has a history of STIs. 
• Early in pregnancy, pregnant people should get tested for syphilis, HIV, hepatitis B, and hepatitis C. Most pregnant people will also be tested for gonorrhea or chlamydia. Some may also need repeat testing.

Additional testing may be recommended based on your unique circumstances. Talk to your health care provider about what STI testing is right for you.

Learn what you can expect from STI testing.

Pelvic exams

Pelvic exams are an important part of sexual and reproductive health care. But, according to the American College of Obstetricians and Gynecologists (ACOG), they should only be conducted when necessary based on symptoms or medical history. As Hey Jane’s Medical Director Alyssa Wagner (DNP, RN, APRN, WHNP-BC) likes to say, there’s no search without probable cause! Meaning that unless there is a reason, it is not recommended to do a pelvic exam. 

The following symptoms might indicate that a pelvic exam is medically necessary:

• Abnormal vaginal bleeding
• Pain during sex
• Pelvic pain
• Sexual dysfunction
• Vaginal dryness
• Vaginal prolapse
• Urinary issues
• Issues with inserting tampons
• Vaginal discharge or odor

Pelvic exams are not required for most forms of birth control. The only birth control method that requires a pelvic exam before using it is the intrauterine device (IUD).

Learn what you can expect from a pelvic exam.

Immunizations

Many people may not realize that there are vaccines for certain diseases related to reproductive and sexual health. There is a vaccine for HPV and hepatitis B, both of which can be transmitted sexually. Some strains of HPV can lead to cervical cancer.

HPV vaccination is typically recommended between the ages of 11 and 12. That said, there are some situations in which adults are still advised to get the vaccine:

• People who are under 26 and haven’t been vaccinated against HPV should get the vaccine to protect themselves against the virus.
• Between age 27 and 45, some people may be advised by their health care provider to get vaccinated against HPV. However, by this age, most people have already been exposed to the virus.

Hepatitis B vaccination is recommended for all adults ages 19-59 (for most people, once you are vaccinated you are immune to HepB for the rest of your life). 

How often should you get checked out in your 20s?

ACOG recommends that people with vaginas should visit with their OB-GYNs at least once every year for general reproductive and sexual wellness. 

Outside of annual visits, there are other times checking in on your reproductive and sexual  health with a health care provider is important:

• When you’re experiencing uncomfortable symptoms
• When you’ve noticed changes in your breasts/chests or periods
• When you want to go on birth control or switch to another birth control
• When you think or know you’ve been exposed to an STI
• When you’re pregnant 

How often should you get a general health checkup in your 20s? This depends on your health status and medical history. Additional screenings and tests will be recommended to prevent, detect, or manage health conditions. If you have a chronic health condition or a family history of one, you can expect to visit with your health care provider more often.

How to get your reproductive and sexual health checked out

Although there are clinical guidelines for people in different age groups, your recommended screenings and tests may vary based on your health status and medical history. Talk to your health care provider about staying on top of your reproductive, sexual, and overall health.

If you have health insurance, know that all health plans cover preventive health services for people with vaginas. (And yes, Hey Jane accepts insurance!) These can include:

• Birth control (unless you have an exempt religious employer)
• Gonorrhea screening
• Hepatitis B screening
• Syphilis screening
• Chlamydia infection screening
• HIV screening and counseling
• STI counseling
• Urinary tract infection (UTI) or other infection screening
• Mammograms
• Cervical cancer screening
• “Well-woman” visits (your annual OB-GYN appointment)

There are other essential reproductive and sexual health services — including abortion care, PrEP (prevention for HIV), emergency contraception, or vaccinations — that may or may not be covered, depending on your age, medical history, and/or health plan. 

What if you don’t have health insurance? Local health departments and organizations may offer free cancer screenings, STI testing, and follow-up services:

• Breast Cancer Assistance Program 
• National Breast and Cervical Cancer Early Detection Program
• Community health clinics
• Title X clinics
• Planned Parenthood

Hey Jane offers safe, supportive, and confidential telemedicine services for many of your reproductive and sexual health needs—including abortion care, birth control, emergency contraception, UTI treatment, yeast infection treatment, bacterial vaginosis treatment, and herpes treatment. 

Connect with a Hey Jane provider within 1 business day to get started on your treatment plan.