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Pap smears and pelvic exams are not the same thing

Every year, I have a hot date with a cold speculum. I wear my best paper gown and always shave well beforehand. I wouldn’t say I enjoy the ritual (“scoot down, no, farther, keep coming, six more inches, really hang your butt off the edge…”), but because I care about my health I do it.

But I (and you) might not have to get an annual pelvic exam anymore. The U.S. Preventive Services Task Force, which advises the federal government on preventive care, concluded that there is not enough evidence to recommend annual pelvic exams for healthy women. According to the group, research has not shown that pelvic exams decrease a woman’s chance of developing illnesses such as ovarian cancer or of dying prematurely. And the American Congress of Obstetricians and Gynecologists gave a lukewarm agreement. This declaration came on the heels of similar announcements that maybe we don’t need to get mammogramsPap smears (not the same thing as a pelvic exam) or even general checkups so often. Are we free from our medical overlords?

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That question is exactly the problem with this debate, says Sherry Ross, physician, OB-GYN and Women’s Health Expert at Providence Saint John’s Health Center in Santa Monica. “The pelvic exam is just a small part of what happens in a yearly gynecological exam and not even the most important part,” she says.

Pelvic exam and pap smear
Image: Karen Cox/SheKnows

A woman’s OB-GYN is often her only point of contact with the health care system and so her doctor has to cover a wide range of women’s health issues, Ross points out. “So much of what comes from researchers focuses on scary, rare things like ovarian cancer and doesn’t put enough focus on the relationship a woman has with her health care provider.”

In addition to the pelvic exam, doctors check for sexually transmitted diseases, breast cancer and other illnesses along with pregnancy, PCOS and physical problems. Gynecologists can also do routine screenings like cholesterol and blood pressure. She points out that many illnesses, like chlamydia, show very subtle symptoms at first that may only be caught by a yearly exam. But women’s health goes far beyond their physical symptoms, she says.

“For me, it’s really about the conversation, the discussion, because so much comes out,” she explains. “I hear about substance abuse, depression, pain during sex, domestic violence and other things that are incredibly important to a woman’s health that they wouldn’t tell me otherwise.” And because women aren’t likely to make an appointment to discuss these “soft” issues, it makes the yearly checkup that much more important.

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Ross is also concerned that the task force’s declaration and the ACOG’s endorsement of it will simply confuse women. For instance, we are still supposed to get regular breast exams and cervical cancer screenings, but the frequency depends on a variety of factors like age, health and prior test results — all of which can be hard to remember. And women who are pregnant and have certain conditions like PCOS, or are at risk for some diseases need regular checkups no matter what. She also worries that this will give insurance companies an excuse not to cover well visits for women, even if they want them.

“Is a pelvic exam costly and a little uncomfortable? Yes,” she says. “But preventative health care is one of the best things a woman can do to advocate for her own health.”

And in a world where doctors increasingly dismiss women’s health concerns, perhaps we do need to take this opportunity to be heard — even if it means doing the scoot-n-spread.

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