Should You Have an Annual Pelvic Exam?

Should You Have an Annual Pelvic Exam?

Conflicting guidelines can confuse the decision. Here’s the lowdown.

Currently, OBGYNs do annual pelvic exams to look for cancers, infections or other conditions. The exam could help detect problems that may not present symptoms or that women feel embarrassed or uncomfortable talking about. Routine pelvic exams can also put a woman’s mind at ease, assuring her that she’s healthy and contributing to her overall wellbeing. 

Many doctors feel these exams are essential, helping to ensure that women—many of whom are getting checkups only once per year—receive adequate preventative care. But not all women’s 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 for most women, concluding that its potential harms outweigh its benefits. The ACP said pelvic exams are only appropriate for women who are pregnant, have certain symptoms or are at an increased risk for gynecologic diseases. 

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 women 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 like ovarian cancer and bacterial vaginosis is low and it doesn’t prevent deaths among asymptomatic, adult women. The ACP noted that for many women, the exam is a major source of anxiety, embarrassment and discomfort, and false findings could lead to unnecessary follow-up procedures

This led the ACP to conclude that harms, including embarrassment, pain and discomfort, weren’t worth the benefits of the screenings.

Experts weigh in
Despite these conclusions, not all women’s health experts have been so quick to jump on board with the ACP’s recommendations. Kevin Windom, MD, an expert in gynecologic medicine and leading gynecologic surgeon, fears that the guidelines could be “dangerous,” potentially discouraging women from the only preventive care they receive annually. And 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 a patient and her OBGYN. ACOG also took care to note: Whatever the decision, it’s important to see an OBGYN for a well-woman visit at least once per year.

Patricia Geraghty, NP, one of the top-rated women’s health nurse practitioners in the US and an expert in the field, says that she “vehemently disagrees” with the ACP guidelines. “The pelvic organs are a part of the female body and deserve the same surveillance as any other part,” 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…no one recommends that we should stop providing weight management care because it makes the individual uncomfortable.”

What you need to know
So, with experts giving such different advice, what should women do?

Geraghty 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 that declines the exam so that I am also confident that she is getting the best care and we are not likely to be missing something.” She advises that women see their OBGYN or a healthcare provider who will address their women’s health issues regularly.

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: Talk with your doctor about whether the exams are 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.” 

Medically reviewed in May 2019. Updated in August 2019. 

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