The annual pelvic exam often dreaded by women may be antiquated and now unnecessary.
Ask any woman about getting a pelvic exam and they will tell you that it is uncomfortable, embarrassing, and seldom yields any results that impact a woman’s healthcare. Now a recent report by the American College of Physicians suggests that the annual pelvic exam is unnecessary.
For decades, doctors have believed this exam may detect problems like ovarian cancer or a bacterial infection even if a woman had no symptoms. And sometimes it does. But recently experts have questioned whether the yearly ritual adds value to a woman’s health.
In the new guidelines, published in the Annals of Internal Medicine, an expert panel appointed by the American College of Physicians recommends that healthy, low-risk women not have routine annual pelvic exams. The panel based this advice on a systematic review of prior studies. They not only found no benefit from the annual pelvic exam, they found that it often causes discomfort and distress. Sometimes it also leads to surgery that is not needed.
The new guidelines only apply to the pelvic exam, and only in healthy women. The panel urged women to keep getting checked for cervical cancer. Also, the experts emphasized that pelvic exams remain a necessary part of the evaluation in any woman with symptoms that could be related to a problem with the vagina, cervix, uterus, Fallopian tubes, or ovaries.
A test women do need
Although seemingly healthy women may not need a pelvic exam every years, being tested regularly for cervical cancer can save a woman’s life. Here are the recommendations for women at average risk of cervical cancer:
• ages 21 to 29: a Pap smear once every 3 years.
• ages 30 to 65: a Pap smear every 3 years or a combination of a Pap smear and HPV test every 5 years.
• over age 65: routine Pap screening not needed if recent tests have been normal.
Keep in mind that these are guidelines. For personal reasons, you and your doctor may wish to choose HPV testing first or have more frequent Pap smears than recommended.
If during a routine appointment your doctor wants to perform a pelvic exam, and you aren’t keen on the idea, feel free to ask why you need it and what he or she is looking for. That’s not a challenge. Based on current evidence, there should be a reason for doing a routine pelvic exam.
Bottom Line: The annual pelvic exam should be a shared decision between doctor and patient. It is reasonable for women to ask their doctor whether a routine pelvic exam is necessary, and to ask for more information on the possible benefits and risks of the examination.