Family Health, Women's Health Ben Brown | 3 years ago

Ask the Expert: Do I Need a Yearly Pelvic Exam?

Millions of women include an annual visit to the gynecologist as part of their preventative health routine each year. For decades, women have been encouraged to do so by everyone from their primary care physicians to their families and friends. But now the American College of Physicians (ACP) is changing their stance on the need for this practice. Recently the group published a new set of guidelines that recommends against annual pelvic exams for healthy, non-pregnant women. They say that the risks posed by pelvic exams may outweigh the benefits for most healthy women. Robert Higgins, MD, FACOG, FACS, who is board certified in obstetrics/gynecology and gynecologic oncology at Carolinas HealthCare System, weighed in on the discussion.

Q: What are your thoughts on the recommendations by the ACP that yearly pelvic exams are not necessary for a healthy woman?

A: The important issue is to determine the purpose of a yearly pelvic exam in asymptomatic women- if the purpose is to detect cancer; an annual pelvic exam fails to reliably detect cancer of the ovary, uterus, cervix, or vagina. However, these exams may be beneficial in detecting skin lesions on the vulva or prolapse of the vagina.

Q:   When are yearly exams appropriate?

A: An annual pelvic exam or any pelvic exam is appropriate if a woman in having pelvic or abdominal pain, unexplained bleeding, vaginal discharge, infertility issues, or pain with intercourse. A pelvic exam is usually performed at the time of a pap smear.

Q:   Many women rely on their OB/GYN to be their primary care physician as well- they may go to them for other issues, such as depression or pain affecting areas other than the pelvic region. If they aren’t getting a yearly pelvic exam, should they still continue to schedule regular appointments with their doctor?

A: An annual appointment with your physician can be beneficial. Women should discuss with their physician any emotional or physical concerns they may be experiencing. The physician can reinforce healthy lifestyle choices and counsel women on appropriate intervals to have screening tests like a mammogram. The type of physical examination needed would be based on symptoms reported by the patient.

Q: What else is important for women to know about this study?

This recommendation to eliminate the annual pelvic examination in asymptomatic women is based on population data. Not all national medical organizations agree with this recommendation. The American College of Obstetrics and Gynecology continues to support annual pelvic examinations. Your physician knows your particular circumstance and may believe it is in your best interest to have a pelvic examination.   1001253

Dr. Higgins is board certified in obstetrics/gynecology and gynecologic oncology. He is a clinical associate professor at the UNC School of Medicine.