Women’s Health: What is a better Pelvic Exam

MOST WOMEN count an annual pelvic exam as a routine part of their health care. In 2014, however, the American College of Physicians—a group of internists, not gynecologists—issued a statement saying there is no value in an annual pelvic exam unless a woman has a specific concern, such as pain or bleeding. Ever since, women have been confused about why and how often they should have the exam. Read on for my answers to four common questions.

Is it true that I don't need an annual pelvic exam if I don't have any specific problems?

“No complaint” does not mean “no problem.” Many conditions don't have symptoms in their early stages, and in other cases women disregard symptoms that are important. They may not recognize that vulvar discoloration can be a sign of vulvar cancer, for example, or may not mention they're experiencing vaginal dryness because they think they need to tolerate it. The American Congress of Obstetricians and Gynecologists and the North American Menopause Society recommend an annual pelvic exam.

Should it include a Pap test?

A Pap test is no longer required every year in low-risk women. How often you should have it depends on your age and prior test results. The guidelines:

• Women ages 21 to 29 should have a test every 3 years.

• Women over 30 should have a Pap test every 3 years or a Pap and HPV test every 5 years.

• Women 65 and older may stop having the tests if they have had three normal results in a row, never smoked, had only normal tests for 10 years, and do not have a new sex partner.

If I don't need a Pap test, why do I need an annual pelvic exam?

A Pap test screens only for cervical cancer, not for other gynecologic cancers or conditions. An annual pelvic exam includes a visual inspection of the external genitalia to check for growths or abnormal skin changes on the vulva; a speculum exam to look inside the vagina and look for abnormal discharge, abnormal growths on the cervix, and changes such as thinning or dryness of vaginal walls; and a bimanual exam in which the physician places one or two fingers into the vagina and a hand on the abdomen to evaluate the uterus and ovaries and check for pelvic masses.

The list of conditions that can be detected during this exam is long and includes vulvar disorders, uterine or bladder prolapse, cervical polyps, ovarian cysts, and fibroid tumors. Even nongynecologic conditions, such as colon cancer, can be detected. This is also your chance to discuss issues such as sexual function or just be reassured that everything is normal.

I dread the speculum exam. Is there any way to make it more comfortable?

The modern speculum was invented (yes, by a man) in 1845. You would think someone would have come up with a better way to view the cervix by now!

Still, the exam shouldn't be excruciating. If placement of the speculum goes beyond “a little pressure” and it pinches or hurts, be sure to speak up. Sometimes making a minor adjustment or switching to a different speculum (they're not one size fits all) can make a world of difference. And lubricant, which may alter the accuracy of a Pap test, can be used when you're not having the test.

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