OBGYNs routinely perform annual pelvic exams. During one, they check the external genitals and insert a speculum into the vagina to see the vagina and cervix. Then, they remove the speculum and do a physical exam by inserting two gloved fingers into the vagina and pressing on the abdomen to examine the uterus and ovaries.
Pelvic exams are done to look for cancers, infections, or other conditions. They can help detect issues that may not present symptoms or that someone may feel embarrassed or uncomfortable talking about. Routine pelvic exams can also provide reassurance that you are healthy.
Many healthcare providers (HCPs) say these exams are essential, helping to ensure their patients—many of whom are getting checkups only once per year—receive adequate preventative care. But not all health experts are convinced that annual pelvic exams are necessary.
In 2014, following a systematic review of published studies, the American College of Physicians (ACP), an organization that represents internal medicine doctors, recommended against yearly pelvic exams for most people, concluding that the potential harms outweigh the benefits. The ACP said pelvic exams are only appropriate for those who are pregnant or have certain symptoms including bleeding, discharge, or urinary issues.
So, with trends in medicine continuing to lean more toward prevention, why would the ACP argue against the exam?
Breaking down the ACP guidelines
During their review, which focused mainly on people of menopausal age and older, the ACP determined that the exam isn’t always effective. It rarely detects noncervical cancers, its accuracy in diagnosing conditions such as ovarian cancer and bacterial vaginosis is low and it doesn’t prevent deaths among asymptomatic adults. The ACP noted that for many people, the exam is a source of anxiety, embarrassment, pain and discomfort, which could lead them to avoid future checkups. Furthermore, false findings could lead to unnecessary follow-up procedures.
This led the ACP to conclude that the potential harms related to the screening weren’t worth the benefits.
Experts weigh in
Despite these conclusions, not all health experts agree with the ACP’s recommendations. Kevin Windom, MD, an expert in gynecologic medicine and surgery, fears that the guidelines could be “dangerous,” potentially discouraging people from the only preventive care they may receive annually. In 2018, a Committee Opinion issued by the American College of Obstetricians and Gynecologists (ACOG) stated that, due to the limited evidence on benefits and harms, the decision should ultimately be left up to someone and their OBGYN. ACOG also stressed that whatever the decision, it’s important to see an OBGYN for a wellness visit at least once per year.
Patricia Geraghty, NP, a nurse practitioner who specializes in gynecological health, says that she “vehemently disagrees” with the ACP guidelines. “The pelvic organs deserve the same surveillance as any other part of the body,” she adds. “The trade-off between missing these issues because of anxiety and discomfort is not really an equation we seem to apply to detecting disorders of other body parts.”
What you need to know
With such conflicting opinions from the experts, it can be difficult to navigate the decision whether or not to schedule an annual pelvic exam.
Geraghty, who stresses the importance of seeing an OBGYN or other HCP regularly, says, “I will advise my patients to continue with routine pelvic exams if they believe that means they are taking better care of themselves. I [would need] to do a very thorough verbal history with any patient who declines the exam so that I am also confident that they are getting the best care and we are not likely to be missing something.”
She also says the following symptoms warrant a pelvic exam:
- Irregular vaginal bleeding
- Changes in vaginal discharge
- Pain with sexual intercourse
- Lower abdominal pain or pelvic pain
Bottom line: If you’re wondering whether you need a routine pelvic exam, discuss your concerns with your HCP who can offer guidance on what is right for you. “Be empowered with this information,” Dr. Windom suggests. “Ask questions. Use it to have a new, more informed dialogue with your doctor.”
Sources: Mayo Clinic. Pelvic exam. Last updated J... + 1
- Mayo Clinic. Pelvic exam. Last updated July 24, 2021.
- Hauk L. ACP Provides Guidance on Screening Pelvic Examination in Women. Am Fam Physician. 2015;91(10):732.
