For most health-conscious women, it is second nature to visit the gynecologist regularly. We have been taught that a yearly pelvic exam is a vital preventative measure- just like visiting the dentist or wearing sunscreen.
But is it really necessary? The American College of Physicians (ACP) doesn’t seem to think so. They now believe that symptom-free females who are not pregnant can ditch their yearly checks with no risk- and they have altered their guidelines to match this claim. Due to this change, doctors are being recommended not to perform pelvic exams on the majority of their patients.
With genital STD’s, infections, and even cancer posing potential threats, why would the ACP suddenly denounce the need for cautionary exams? For one, they have found these check-ups to be generally inconclusive. A study included in their recently published Annals of Internal Medicine showed that the majority of pelvic exams do not detect disease nor reduce mortality. If anything is seriously wrong, more in-depth tests and screenings are usually needed to diagnose.
Even so, is it appropriate to throw the baby out with the bath water? Just because an exam does not normally uncover disease does not mean it is unable to do so. A seatbelt may not be necessary on a day to day basis, but that one day may come around where you are happy you had it on. Buying a car with airbags will not directly reduce your mortality, but having those airbags there when you get into an accident probably will. This falls into a similar category- as a “better safe than sorry” approach to conscious living.
Price is another major factor for this shift in routine. The ACP argues that patients should not have to shell out the cash for an exam that is unlikely to yield worthwhile information. It’s common knowledge that medical services of any kind are not cheap, but gynecological exams are on the lower end of the spectrum- at around $100 without insurance. While no patient has to do anything compulsorily, some might decide that peace of mind is worth the price of a pair of shoes (albeit nice ones).
But the far most troubling reason for the ACP’s avoidance of yearly exams is the possibility of causing “fear, anxiety, pain and discomfort” in patients. This is a valid concern- especially for those who have a history of sexual abuse or trauma. However, finding out that you have a disease that has gone undiagnosed probably also elicits these feelings. I think it is worth exposing yourself to a little discomfort once a year to save you from the risk of long-term pain down the road.
Not only that, but exams can uncover complications that patients are too anxious to bring up in the first place. It is not uncommon for someone to avoid mentioning a symptom because they are embarrassed. And let’s not forget about the diseases such as chlamydia and herpes that can often be asymptomatic. If it weren’t for a pelvic exam, these cases would likely fly under the radar.
My stance on the new guidelines is no doubt critical. Of course visiting the gynecologist is not fun and easy, but that is no reason stop. That being said, the American College of Physicians is onto something. Efficiency, cost, and productivity of current medical practices are issues that should be addressed. Perhaps we should focus on revising standard pelvic examinations rather than bypassing them entirely.
What are your thoughts on the ACP’s new guidelines? Are pelvic exams helpful or harmful?
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