We all know how delicate our health “down there” is. No tight clothes should be worn, special care need to be taken during summer time while on the beach, hygiene should be a top priority and of course, regular doctor’s appointments for a pelvic exam are also essential. Or this later part is not so essential after all?
Start a Google search on “pelvic examination” and you will see a number of articles about how pelvic exams are no longer necessary unless you have a symptom, how it is an exam that instead of offering significant benefits it provides women with discomfort and embarrassment and how you should start saying “no” to your annual doctor’s appointment.
Before we jump to any conclusions, however, it is best to know all the facts. So, let’s take the story from the beginning.
What is a pelvic exam?
A pelvic exam is a way for doctors to visually and manually assesses a woman’s reproductive organs. You might have a pelvic exam as part of your regular checkup (in my country it is done annually), or your doctor may recommend a pelvic exam if you have symptoms such as unusual vaginal discharge or pelvic pain.
It is a relatively short procedure, during which your doctor checks your vulva (external genital organs), vagina, cervix, uterus (the womb), pelvis, including your ovaries, and often rectum, for masses, growths or other abnormalities.
A pelvic exam generally includes:
- an external visual exam, to check for irritation, redness, sores, swelling.
- an internal visual exam, using a speculum to spread open your vaginal walls in order to view your vagina and cervix. At this step, a Pap test, which screens for cervical cancer, may be performed.
- a bimanual exam, where your doctor inserts two lubricated, gloved fingers into your vagina with one hand, while the other hand presses gently on the outside of your lower abdomen, to check the size and shape of your uterus and ovaries, noting points of tenderness or unusual growths
Why is it done?
A. To check your gynecological health for possible signs of a variety of disorders like:
- uterine fibroids, ovarian cysts, or uterine prolapse
- vaginal infections, such as yeast infections or bacterial vaginosis
- sexually transmitted infections (STIs), such as chlamydia, herpes, gonorrhea, trichomoniasis, or human papillomavirus (HPV)
- early-stage cancer
B. To evaluate and determine the cause of gynecological symptoms like:
- abnormal uterine bleeding
- abdominal or pelvic pain
- skin changes
- abnormal vaginal discharge or urinary problems
C. Before prescribing a method of birth control (contraception), since some methods of birth control, such as a diaphragm or intrauterine device, require a pelvic exam to make sure the device fits properly.
D. To collect evidence in cases of suspected sexual assault.
As women we all know how uncomfortable such an exam is. Whenever I have an appointment with my gynecologist I get anxious days in advance and I am sure you do too. After all, a pelvic exam is not as simple as an eye exam for new prescription glasses.
So, when a recent review by the American College of Physicians (ACP) was published stating that the pelvic exam has no benefit to asymptomatic women a big stir was created. Still, is this something we should take for granted so lightheartedly?
ACP’s new evidence-based clinical practice guideline, “Screening Pelvic Examination in Adult Women,” was published in Annals of Internal Medicine, ACP’s flagship journal at the end of June and is based on a systematic review of the published literature on human subjects in the English language from 1946 through January 2014.
Dr Linda Humphrey, a co-author of the guideline and a member of ACP’s Clinical Practice Guidelines Committee states that, even though this guideline does not apply to Pap smear screening, “routine pelvic examination has not been shown to benefit asymptomatic, average risk, non-pregnant women. It rarely detects important disease and does not reduce mortality and is associated with discomfort for many women, false positive and negative examinations, and extra cost.”
ACP states that when screening for cervical cancer the bimanual examination is not necessary but instead the recommended examination should be limited to visual inspection of the cervix and cervical swabs for cancer and for some women human papillomavirus (HPV). ACP found that the diagnostic accuracy of the pelvic examination for detecting gynecologic cancer or infections is low and advises that the pelvic examination is appropriate for women with actual symptoms, such as vaginal discharge, abnormal bleeding, pain, urinary problems, or sexual dysfunction.
So far so good, or maybe not, at least not for me. As a woman and one that works in the medical field, I cannot help but wonder what the possible consequences of this might be. There are plenty of studies showing the Pap smear saves lives, but does a visual and manual inspection do any good?
ACP seems to be extremely concerned about how a woman feels during such an examination, which is extremely thoughtful and caring, but is a little discomfort enough of a reason to avoid something that can ultimately save your life?
Dr. Molly Cooke, ACP’s Immediate Past President and a member of ACP’s Clinical Practice Guidelines Committee, also stated that while in the past the bimanual exam was used to screen for benign lesions and ovarian cancer, nowadays this should change as ovarian cancer is extremely rare. Also, women who are most at risk for developing the disease either have the BRCA gene mutation or have undergone ovary-stimulating fertility treatments in the past.
Since I wonder, how many women know what the BRCA gene mutation is? How many women know whether they are at risk of having an BRCA gene mutation? Many probably heard about this gene mutation when Angelina Jolie underwent a double mastectomy because of it but how many women know who and why someone should get tested? Not enough, I would say.
And the list of questions continues: does asymptomatic really means danger-free? How long does it take for ovarian or cervical cancer to show any symptoms? Can vaginal infections exist without showing any symptoms?
Some might say that if you are not sexually active, there is no need for a routine gyno exam, as there is also no need if you are in a serious relationship. Still, are you sure that your partner is not unfaithful?
My day-to-day encounter with women lead to the worrying conclusion that, unfortunately, many women regardless of their age and educational background, are unaware of the potential benefits an annual visit to their gynecologist has or the potential risks they are under if they don’t get routinely checked.
I personally believe that it all comes down to how well-educated women are regarding their gynecological health and the potential risks. Many women will use ACP’s review as an excuse to skip their gynecological health checks, because they make them feel uncomfortable and all the other reasons ACP mentions (embarrassment, anxiety) that can make a woman skip a pelvic exam.
Before you do something so drastic as canceling your annual pelvic exam, though, talk to your doctor about the potential benefits and/or consequences such a thing might have on your health.
Yes, a visit to a gynecologist is one of the most uncomfortable things for any woman but is discomfort worth more than your overall health?