Ladies, in case you haven’t heard, you don’t have to endure annual pelvic exams anymore. No more poking and prodding with your feet up in stirrups every year. You heard me right! If you’re healthy and not pregnant, the American College of Physicians says that annual gynecologic pelvic exams—no matter what your age—don’t really do much health-wise and are not needed. In fact, the College says that the harms, including fear, anxiety, embarrassment, pain and discomfort, outweigh the potential benefits.

That’s great, but not all doctors agree with this. And, frankly, you should wonder, too. At best, as with proposed changes about mammography screening, it puts the responsibility for well-being back into the hands of women. That’s empowering. But to really make the right decision, a woman needs to be well-informed. Here’s what you need to know to make the best decision about when or whether you should get a pelvic exam…


Whether women need annual pelvic exams has been under hot debate since the American College of Physicians said No, they don’t in its recently updated guidelines. I spoke with two gynecologic oncologists—both from the Memorial Sloan Kettering Cancer Center in New York City—who, although colleagues, have two very different opinions on the matter. Who’s right? Hearing both sides may help you come to the right decision for you.

Pelvic exams, in theory, are done to check for skin growths or rashes or signs of infection, inflammation, tumor growth or other abnormalities of the pubic area, vagina, cervix, uterus and ovaries. “But it’s all basically done for the sake of tradition. The value of the examination is not based on published scientific evidence,” said Mario M. Leitao, Jr., MD, codirector of robotic surgery in the department of gynecology at Sloan Kettering.

Dr. Leitao went on to say that “even in women who are in their 60s and 70s, there’s still no advantage to these exams if they have no medical problems.” Instead, Dr. Leitao recommends that women follow guidelines recommended by the American Cancer Society and other medical societies dedicated to cancer prevention and detection.

The American College of Physicians guidelines say that instead of a full pelvic exam, women age 21 to 30 should just have a Pap smear to assess gynecologic cancer risk every three years and women age 30 to 65 should either have a Pap smear every three years or a Pap smear plus a test for human papillomavirus (HPV) every five years. (HPV is a very common sexually transmitted virus that causes genital warts and, if left unchecked, can cause cervical cancer.) Women older than 65 no longer need to have Pap smears or HPV tests if they’ve had a clean bill of health throughout their lives. Otherwise, they should continue to get Pap smears every three years until they’re into their 80s.


Now, how about the other side of this? Although Oliver Zivanovic, MD, PhD, director of innovative surgical technology in the department of gynecology at Sloan Kettering, agrees with Dr. Leitao about Pap smear screening and HPV testing, he disagrees with him about the American College of Physicians guidelines about annual pelvic exams. “Pelvic exams are very important to helping doctors detect abnormalities. They provide findings that can save a woman’s life.”

Yet another professional association—The American College of Obstetricians and Gynecologists (ACOG)—also supports regular pelvic exams. Its position is that the traditional pelvic exam described above should be done every year even for healthy women. Besides picking up on possible diseases and other medical problems, the time spent with the doctor during the exam builds a doctor-patient relationship, according to ACOG.

Dr. Leitao agrees that this is a good point, but says an annual gynecologic exam is mainly of value for the woman who uses a gynecologist as a primary care physician because it presents an opportunity for her to discuss medical issues with a professional and make sure she is getting regular health care.

He also points out that pelvic exams aren’t free, despite the fact that most insurance plans include them at no out-of-pocket expense to the patient. “These unnecessary exams are costing us billions of dollars a year,” said Dr. Leitao (about $2.6 billion annually, according to the American College of Physicians). “They are financial burdens for women without insurance. For those with insurance or who are on Medicare or Medicaid, the costs put a burden on the health-care system, which impacts the overall cost of health care and impacts the economy.” But, in Dr. Zivanovic’s view, pelvic exams are an inexpensive way to keep women—as individuals—safe. “A hundred dollars or so a year per woman is worth it to save a human life,” he said. Additionally, he believes that a woman should begin annual pelvic exams when she becomes sexually active even if she is younger than 21.


Besides keeping up with cervical cancer screening, Drs. Leitao and Zivanovic, of course, agree that when gynecologic symptoms, such as an unusual discharge, rash or skin growth, appear, a woman should get to her OB/GYN right away. Above all, they agree that the decision to stop or continue annual pelvic exams should not be one-sided but a shared decision between a woman and her doctor after fully discussing her specific medical history and all of the pros and cons of the issue.

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