Your reproductive and sexual health care checklist for your 40s

For many people, entering their 40s feels like a big milestone: Whether you’ve started a family, have hit your career stride, or are having the best sex of your life—or all three at once—you’ve been in your body for four decades.

Which means that your reproductive and sexual health is incredibly important, especially if you want to stay healthy and get ahead of issues.

We reviewed the clinical guidelines and recommendations for people with vaginas in their 40s so you know what to keep track of 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 sexual health screenings should you get in your 40s?

When it comes to reproductive and sexual health, you might be wondering: What medical tests do I need in my 40s? 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 40s get cervical cancer screenings at a frequency based on their age and history of pap smear screenings. Screenings for people in their 40s include Pap tests and/or human papillomavirus (HPV) testing. 

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.

People with cervixes who are in their 40s are advised to meet one of the following guidelines:

• Get HPV tests every five years
• Get HPV tests along with Pap tests every five years
• Get Pap tests every three years

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

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.

Breast cancer screening

Like cervical cancer screenings, the American Cancer Society recommends that people assigned female at birth who are in their 40s get breast cancer screenings at a frequency based on their age and risk level. Screenings for people in their 40s include breast/chest magnetic resonance imaging (MRI) and mammograms.

Breast/chest MRI takes detailed images of the inside of breasts/chests to detect breast cancer signs among people with high risk for the cancer. 

Mammograms are low-dose x-rays that help detect breast cancer early — before there are physical symptoms to suggest it. 

These are the breast cancer screening guidelines for people in their 40s:

• People with high risk of breast cancer may have started screening with breast/chest MRIs and mammograms at age 30.
• People who have an “average” risk level have the option of starting mammograms at age 40.
• People ages 45-54 should be screened annually or every other year for breast cancer using mammograms.

That said, there is growing research that Black patients need earlier and more frequent screening for breast cancer. That’s because of major health disparities with care, and the odds of dying from breast cancer are much higher than white patients. 

Learn what you can expect from a breast/chest MRI and mammogram.

While you may have previously heard that you should be self-examining your breasts every month, what is now recommended is what’s called “breast self awareness”—doing your best to get familiar with your breasts (including what they feel and look like), so you can learn what is normal for you. If you notice nipple discharge, lumps or bumps, or other changes, let your health care provider know. And don’t be afraid to ask your provider to teach you what to do and how to look for changes—a good provider will spend time talking you through it! 

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, pregnancy complications, and birth defects down the line.

The following STI tests are recommended for people with vaginas in and beyond their 40s:

• Anyone ages 13-64 should get an human immunodeficiency virus (HIV) test at least once.
• People should 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. One other thing to note is that it’s important to tell your health care provider where you have sex, because STIs can live in your throat, vagina, penis, or anus (all of which can be tested, too).
• Early in pregnancy, pregnant people should get tested for syphilis, HIV, hepatitis B, and hepatitis C. Pregnant people will also be tested for gonorrhea or chlamydia. Some may also need repeat testing.
• Everyone should get a hepatitis C test at least once in their lifetime—if you haven’t yet, now may be the time.

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.

Diabetes screening

Diabetes is a health condition where the body has difficulty regulating its levels of blood sugar. Issues with blood-sugar control like diabetes or insulin resistance can impact menstrual cycles and make it harder to get pregnant. People who have diabetes are also monitored more closely in pregnancy. Uncontrolled diabetes can cause pregnancy and birth complications.

Diabetes screenings are recommended at a frequency based on age, body-fat percentage (based on body-mass index), and pregnancy status. Screenings include testing A1C or oral glucose tolerance tests.

Diabetes screenings are also recommended for pregnant people. Screenings include glucose screening tests and glucose intolerance tests.

A1C tests examine the average blood-sugar levels from the prior 2-3 months.

Glucose tolerance tests measure blood-sugar levels before and after drinking a high-glucose beverage.

Glucose screening tests measure blood-sugar levels after drinking a high-glucose beverage.

Diabetes screening guidelines are different for different people:

• Nonpregnant people ages 35-70 should be screened every three years for diabetes.
• Pregnant people should be screened between the 24th and 28th weeks of pregnancy.

Learn what you can expect from diabetes screenings.

Pelvic exams

Pelvic exams are an important part of reproductive and sexual 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—so unless there is a reason, it is not recommended.

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

Unless you are planning on getting an intrauterine device (IUD), a pelvic exam is not required for most forms of birth control.

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. Between age 27-45, some people may be advised by their healthcare provider to get vaccinated against HPV. However, by this age, most people have already been exposed to the virus.

If you haven’t yet been vaccinated for hepatitis B, that is also recommended for all adults ages 19-59.

How often should you get checked out in your 40s?

ACOG recommends that people with vaginas should visit with their OB-GYNs at least once every year for general reproductive and sexual wellness, including in their 40s. 

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

• When you’re experiencing vaginal symptoms (unusual discharge, odor, changes in bleeding patterns)
• When you’ve noticed changes in your breasts/chests
• 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 
• If you want to discuss not getting pregnant

How often should you get a general health checkup in your 40s? This depends on your health status and medical history. Some health care providers suggest having physical exams every year starting at age 40. 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 healthcare 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 healthcare provider about staying on top of your sexual, reproductive, and overall health.

If you have health insurance, know that all health plans cover preventive health services for people with vaginas. 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)

Your insurance may also cover other essential reproductive and sexual health service — such as abortion care, Prep (prevention for HIV), emergency contraception or vaccinations — depending on your age, medical history, and/or health plan. (Hey Jane does accept insurance, FYI!)

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.