Maxy sez: No Pelvic Exam? Why You Should Care 'Down There'

 author-avatar By Lauren Streicher, MD
Your pelvis, or at least the health of your pelvis, is under attack with the new "no-pelvic exam" advice. And it's time to fight back.

A little background: Every year, millions of women make that annual trek to their gynecologist, internist, or family doctor, and reluctantly climb into the stirrups and put up with a less than comfortable, sometimes humiliating exam. No one likes it, but from my point of view, it's clearly worth the brief discomfort and possible embarrassment to make sure that all is well in gyne-land.

But not every professional medical organization is in agreement about the value of routinely checking out the vulva, vagina, and pelvic organs. In 2014, the American College of Physicians (internists, not gynecologists) issued a statement that there was no value in an annual pelvic exam unless someone had a specific complaint. But common sense will tell you that “no complaint” does not mean “no problem.”

Signs and Symptoms Seen in a Pelvic Exam Matter

Many women may not recognize that their vulvar itching could be the first sign of vulvar cancer. Most women assume that there's no treatment for painful sex and vaginal dryness, so they don’t bother to mention it. In still other cases, a woman may assume her urinary incontinence is an inevitable consequence of aging and frequent the diaper aisle instead of getting appropriate treatment.

And most disturbing, a serious condition such as vaginal cancer may have no symptoms but be easily detectable by a gynecologist via a simple speculum examination of the vaginal walls.

You can’t treat something if you don't know it's there, and it's been well established that being asymptomatic is NOT the same as being healthy.

The No-Pelvic Exam Statement by the USPSTF

June 2016, the U.S. Preventive Services Task Force (USPSTF) released a statement that questions the value of routine gynecologic exams. But here’s the astonishing part: The authors of the report looked at only four — that’s right, four — conditions:

Ovarian cancer
Bacterial vaginosis, a common vaginal infection
Trichomoniasis, a sexually transmitted disease
Genital herpes
They inexplicably concluded that since there was no benefit to a pelvic exam in diagnosing these specific conditions, an annual pelvic exam need not be performed for otherwise healthy women. This argument is so outrageous, so flawed, and so beyond the most basic logic that I am embarrassed for them.

For starters, it has already been well established in the medical literature that ovarian cancer isn't detected on annual exams. Genital herpes is diagnosed only if it's active, and bacterial vaginosis and trichomoniasis are detected only if a specific screen is performed. In other words, it's not news that these particular four conditions are not generally going to be diagnosed during an annual exam. Any gynecologist will tell you that these conditions are not the reason for the exam!

Ovarian cancer, bacterial vaginosis, trichomoniasis, and genital herpes don't even represent a fraction of the sorts of conditions a gynecologist screens for during your pelvic exam.

The Value of the Pelvic Exam After Menopause

The executive committee of the North American Menopause Society (NAMS) has come out publicly and stated, on July 1, that they “strongly disagree with the conclusion of the USPSTF draft evidence review, particularly as it applies to postmenopausal women.” And while it might be “reasonable to recommend against the pelvic exam for diagnosing those four conditions, there is no scientific basis for extrapolating beyond those four specific conditions to the myriad of conditions that affect women.”

It appears that women are perilously close to losing the right to a complete exam, with consequences that may not be evident for years.

But there's something you can do that may change this recommendation.

Public Comments on the Pelvic Exam Are Open

The USPSTF has declared that this statement is only a draft and that they are willing to “hear public input” prior to making a final recommendation. Quite frankly, it’s pretty frightening that this recommendation will be based on public opinion as opposed to solid science. What’s next, a public “vote" on whether taking blood pressure is important?

In any event, you have until July 25 to go to the USPSTF site and read the report yourself, and to then leave a comment if you disagree with this recommendation.

You may want to tell the USPSTF about a condition that was diagnosed that you had no idea you had until it was discovered on a pelvic exam. Or you may want to explain that your annual gynecologic exam is your opportunity to discuss “below the belt” issues, such as incontinence or sexual function — or that it's your opportunity to simply be reassured that everything is normal instead of treating your genitalia like some kind of no-fly zone that's only examined or treated if you have excruciating pain, a zoo-like odor, or bleeding requiring a change of pad every 10 minutes.

Or you may simply want to tell the USPSTF that you are offended that, once again, women’s heath is marginalized by encouraging doctors and insurance companies to forego this critical part of your annual exam. And while you're at it, ask for “proof” that listening to your lungs and heart, a screen performed by every internist, is an effective way to reduce mortality and improve quality of life.

Important: The views and opinions expressed in this article are those of the author and not Everyday Health.