By Elina Pfaffenbach, MD – Obstetrician/Gynecologist
There have been a lot of questions about the recent publication of a new set of guidelines issued by the American College of Physicians (ACP) recommending against annual pelvic exams for healthy, nonpregnant women. The doctors and nurse practitioners at Women’s Health Specialists follow the guidelines established by the American College of Obstetricians and Gynecologists (ACOG): We firmly believe in the clinical value of routine pelvic exams. In our opinion, the decision to proceed with a pelvic examination is one a woman should make in conjunction with her healthcare provider, based on the patient’s individual needs, requests, and preferences!
To stay healthy, women should have a physical exam every year. Most of the time, the pelvic examination is a part of this annual exam. For the younger patient in her teens, who comes in for a routine exam, the pelvic portion can often be skipped, assuming she has no complaints and has had normal periods. If she is sexually active and has NOT used consistent barrier contraception, screening for sexually transmitted infections (STIs) is recommended because often times STIs don’t have symptoms; but if not diagnosed and treated, STIs can cause scarring of the fallopian tubes and infertility later on in life.
The pelvic portion of the annual exam can also help to identify other STIs, such as genital warts that may NOT be obvious to the patient, but if not treated they can be spread to another partner. Ovarian cysts and fibroid tumors can be discovered during a pelvic exam and in older patients, cancers of the genital tract. These genital skin cancers don’t have symptoms and, as you can imagine, this area is almost impossible to examine by yourself! There are also rare vaginal abnormalities that a woman can be born with, which can only be diagnosed through a physical exam.
The ACP stated that, based on some studies, pelvic exams did not show any benefit to screening for ovarian cancer, but no studies were found to address the accuracy of pelvic exams for the other conditions described above (STIs, other gynecologic cancers, fibroids, and vaginal abnormalities). Although these other conditions may not be fatal like ovarian cancer, they are important for a woman to know about! Sometimes these disorders need treatment, other times awareness about what you have is sufficient. The pelvic exam is a time for the physician or healthcare provider to explain female anatomy, provide reassurance of normal anatomy, and answer specific questions.
Pelvic exams represent only one part of the annual well-woman visit, which can help to identify health risks for women. The well-woman visit also includes a clinical breast exam, immunizations, contraceptive care discussions, and healthcare counseling.
Women’s Health Specialists maintains that the annual well-woman visit gives us the opportunity to discuss healthy lifestyles, evaluate risks for medical problems, and identify problems that are already there. Always talk to your OB-GYN about any questions you may have regarding an annual pelvic exam!