The annual pelvic exam. No one likes it. It’s quite unpleasant. It may even prevent patients from seeking a yearly well-visit. So is it really necessary?
The American College of of Obstetricians and Gynecologists (ACOG) seem to think so. They still recommend a yearly pelvic exam, despite the fact that there is no evidence to support its efficacy as a screening process. And they also acknowledge that the evidence neither supports nor denies its value.
In July of 2014, the American College of Physicians released new guidelines stating that healthy, asymptomatic women do not need a yearly pelvic exam. Through a review of the literature dating back to 1946, they concluded that no evidence has been found to support the practice.
So why are we still getting pelvic exams?
To put it simply, old habits die hard. The yearly pelvic exam is something that doctors and practitioners have long been trained to do, so it will take a long time to change that habit. There’s also a misconception among doctors that the pelvic exam actually is an effective screen for ovarian cancer, while no evidence actually supports this.
One of the justifications I’ve always heard is that a thorough exam can detect things like fibroids, infections, or cancer. And someone always has a story about “someone they know” that was saved by a thorough exam. But these kinds of justifications are purely anecdotal. What they don’t take into account is how much damage is done to the patient when a doctor finds something, proceeds with exploratory surgery, or a biopsy, only to find that it was benign. That patient probably went through a a lot of time and worry thinking they had cancer, when actually it was nothing. This kind of worry takes its toll.
In the end I guess you need to ask yourself, are you more comfortable leaving no stone unturned? Or are you more comfortable with the “what I don’t know won’t hurt me” approach? Either way, chances are you’re going to get that yearly pelvic exam. It might be worth asking your doctor what exactly it is she is looking for in there.