In the News: The Pelvic Exam Controversy

The annual visit to the gynecologist for a routine Pap smear and pelvic exam is the time of year most women look forward to the most. Every time I walk into the exam room, I can see it in a patient’s eyes. Women cannot wait to put their feet into those cold stirrups, arranging themselves into a very vulnerable position while their doctor invades their privacy. In reality, it can be hard to motivate yourself for your annual “Well Woman” exam.

Recently the New York Times published an article called “Pelvic Exams May Not be Needed,” based on a study conducted by an influential government task force on preventive services in the U.S.

Needless to say, women everywhere were jumping for joy. But before you get too excited, perhaps we should step back and look at the point of the exam.

Several years ago, the Pap smear guidelines changed. We used to recommend women get a Pap smear every year, but now we start Pap smears at age 21 and perform them every three years. From the ages of 30 to 65, we recommend a Pap smear every five years, as long as the Pap comes back negative, and the patient is negative for having human papillomavirus (HPV), which can cause cervical cancer.

To clarify, a Pap smear is different from a pelvic exam. I realize most patients think they are the same thing. During a Pap smear, we use small brushes to scrape or brush the cells on the cervix (the cervix is the bottom part of the uterus, a.k.a. the area that dilates to allow a baby to come through in labor) to check for abnormal or precancerous cells.

A pelvic exam involves a visual exam of the vagina, as well as an internal exam where a doctor inserts a gloved finger from one hand into a woman’s vagina while the other hand presses her abdomen to detect the size and shape of the uterus and the ovaries, and find any abnormalities such as pain, cysts or masses.

Why do some people think these are not important exams? Mainly because of a lack of large-scale studies by researchers in the medical community. Because of this absence of solid scientific proof, some people believe a pelvic exam may not be necessary, unless a patient has a particular symptom or concern.

But please note: the American College of Obstetricians and Gynecologists, which sets the guidelines for OB/GYNs, still recommends a yearly pelvic exam. No one should be forced into an exam, but it is difficult for a doctor to say everything is OK if you have not had a complete pelvic exam.

Although we know statistically that a pelvic exam does not prolong life expectancy from ovarian cancer, to those rare women who do get their cancer detected early from a pelvic exam, it's hard to argue against doing an exam. And even though there are no studies that say we MUST perform this exam, as a physician, an exam has always been how I take care of a patient. How can I not touch and look at someone and still say everything is normal?

Finally, there is something to be said about the relief women feel after completing their annual exam. I understand it’s not something to look forward to, but I believe many women feel a sense of accomplishment and peace when their doctor tells them everything is normal.

One other point: there are times when a woman might feel too uncomfortable to disclose a concern to her doctor, but a pelvic exam can pick up on many gynecological conditions, anyway.

What do I tell my patients? “You don’t need a Pap smear every year, but we still want to see you for a pelvic exam."

Why? No one else is truly looking “down there,” and most women aren’t checking out their vaginas every day. Even if a patient isn’t reporting an abnormal symptom, there could be a lesion, abnormal mole, or an anatomical abnormality that might not be discovered without a pelvic exam. I believe talking through the exam with my patients can help them relax and better understand what and why we do the things we do, especially with the pelvic exam.

The bottom line? For now ladies, please continue to get all your lady parts, including breast, vagina, uterus, and ovaries, examined on a regular basis. If you would like to know more about menopause and pelvic exams, please read our post: More Important Information About Pelvic Exams.

Courtney A. Seacat, M.D., is an OB/GYN physician. She practices at INTEGRIS Women’s Health Edmond. Dr. Seacat received her medical degree from the University of Kansas School of Medicine in Kansas City and completed her residency at the University of Oklahoma. Her special interests include prenatal care, birth plans, preventive health care, general gynecology, teen health and contraception counseling. She can be reached at 405-657-3825.