In July, the American College of Physicians (the governing body that sets the standards for how doctors in the U.S. practice medicine) recommended changes to the annual well-woman exam. A panel of experts looked at over sixty years of scientific studies on conditions such as cancer, infections, and pelvic inflammatory disease. This led them to question the value of one part of the well-woman check up, the pelvic exam. In particular they questioned whether all adult women need this exam each and every year.
Ladies, you may be thinking- Wow, I’m off the hook! Well, not exactly, read on…..
The well woman exam has three parts– Breast exam, Pelvic exam, and Screening and Diagnostic tests, the most important being the Pap Smear screening for cervical cancer. The Pelvic exam consists of three parts- an inspection of the external genitalia, an inspection of the internal organs (using a tool called a speculum to see the cervix and vaginal walls), and a manual exam to feel the cervix, uterus, ovaries and fallopian tubes (in which the doctor inserts two-fingers into the vagina and presses on your abdomen).
After a review of all available studies, the panel recommended that if a woman is low-risk she does not need a pelvic exam each and every year. Low risk in this case means: non-pregnant, no symptoms that would indicate illness, no present illness, no history of illness, or no relevant family history of illness.
This recommendation is a huge deal for health care practitioners and has led to a lot of heated discussion. The Pelvic exam is often part of the routine when women come in for prescription birth control. Some doctors are reluctant to change their practice. Some women (including women who have difficulty accessing health care due to poverty, language barriers, etc..) may not see a doctor for years, and doctors that work in these health clinics feel that they need to catch women in the moment.
Other doctors welcome the recommendation. Colombia University professor Dr. Carolyn Westoff is one doctor who has looked critically at why doctors have insisted on this exam for many years. She wrote in The Journal of Women’s Health that frequent pelvic exams “may partly explain why U.S. rates of ovarian cystectomy and hysterectomy are more than twice as high as rates in European countries, where the use of the pelvic examination is limited to symptomatic women.”
There are several groups wrestling with this issue- the doctors and medical associations (in charge of your health), insurance companies (in charge of the health care spending), and legal folks (thinking about safety and consumer protections).
But while they hash this out- what should women do?
Here is some advice:
1) Continue to schedule your annual exam. Just because one test or procedure is being reevaluated, doesn’t mean we should “toss the baby out with the bathwater”. You need a check up to catch some major stuff, like heart disease (leading killer of women in the U.S) and other scary stuff like diabetes. And, importantly, you still need the other parts of the well woman exam, specifically the breast exam and screening tests such as the Pap smear.
2) Follow your doctors advice. Your doctor or nurse practitioner will treat you as an individual, looking at your personal history and risk factors. If you need a pelvic exam they will give you one. There are also specific recommendations of frequency of Pap smear and Mammograms. Your doctor will tell you if you need these tests every year, or as is the case for most healthy women, you may need certain tests every two or three years.
3) Share your concerns with your doctor. Many women (see the SuzyKnew! posting on vaginismus) have real difficulty with a pelvic exam and may even avoid going to the doctor because of fear or pain. If this is you, than the new recommendation may be music to your ears! In any case, find a doctor that you can relate to and you can speak to comfortably.