Why Annual Pelvic Exams Are Still Important, Despite a New Survey of Doctors That Implies the Opposite



Earlier this week, the results of yet another survey were released saying that annual pelvic exams have no proven benefits for the millions of women who undergo them each year, adding to the confusion many women are experiencing about WTF we’re supposed to do at our yearly ob-gyn visits. (Do we have to go? Do we need a Pap smear or just urine sample testing? Can we go every other year instead?)

This latest 71-page report was conducted by the seemingly authoritative U.S. Preventive Services, a task force that advises the government on preventive health care, and backed by the American Congress of Obstetricians and Gynecologists. But there are tons of reasons why we women need to question the conclusion that there is “little to no evidence that [annual pelvic exams] benefit asymptomatic women.”

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When the American College of Physicians first raised this issue in 2014, suggesting that healthy women (over the age of 18, not pregnant, and without any symptoms) don’t need pelvic exams as part of their annual checkups, the reactions from the public and medical professions alike were, predictably, mixed, and the debate has essentially been raging ever since.

“I agree with the point that the system isn’t perfect when it comes to detecting ovarian cancer, but who’s to say that’s all you’re using it for?” says Loryn Ashton, a women’s-health nurse practitioner with Maven digital health clinic. “My concern is that if we don’t do pelvic exams and only do Pap smears on women every three to five years, what are we going to be missing? When else do women get a chance to be alone in a room with a physician, where there’s an in-person intimacy and privacy? Yearly pelvic exams are often the only appointment that women go to alone.”

Ashton stresses that it’s incredibly common to discover unnoticed symptoms or issues, from physical ones to emotional ones, during the course of a pelvic exam—things that the patient probably wouldn’t have come in for on their own. “I can’t tell you how many times I’ll see a mole or something going on on a woman’s labia and say, ‘Did you know this was here? Have you had it checked?'” she says. “The pelvic exams bring up a lot of other topics, including sexual abuse. Patients respond to the connection of touch. I’ve caught people with early-stage ovarian cancer just from an exam.”

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The truth is, once a year isn’t that often in the first place, so what’s with the sudden spotlight on making pelvic exams even rarer? Money and politics are inevitable factors, says Ashton. “They make it all about the numbers and the stats, saying it’s OK to lose a few lives if it means saving a ton of money that can go into other health-care needs and research—but that’s not necessarily where it goes.”

And let’s not forget about the gender aspect of all this. Although advocates might compare the current conversation around women’s pelvic exams to the one that’s been had in the past about men’s prostate screenings, it’s not necessarily the same, says Ashton. “Why is women’s health being vetted and checked?” she asks. “Why are we supposed to compromise again? It’s been this way forever—we had to fight for birth control, for everything. We’re finally able to get care, so why should we give it up now?”

Good question. If you’re concerned about the way things seem to be going, you can leave a comment on the task force’s web page through July 25, after which it will issue a final recommendation. And that recommendation will affect which procedures the government and insurance companies decide to cover. Translation: Your annual pelvic exam might not be covered in the future. And that would suck, but Ashton says you can still advocate for yourself, and your doctors will do the same.

“They can recommend all day long, but that doesn’t mean we have to do it,” says Ashton. “We went into medicine to help a patient make appropriate decisions for herself. As I always say to my patients, ‘It’s your choice not to get a Pap smear, but wouldn’t you rather spend 40 minutes per year taking care of business? It’s just not worth missing something.'” And in the meantime, schedule that yearly pelvic exam while your insurance still covers it.

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