Women take note: It’s graduation time from pelvic exams. The US Preventitve Services Task Force (USPSTF) announced this week that there is not enough evidence to recommend routine pelvic exams. In 2014, the American College of Physicians (ACP) also found that routine pelvic exams were of no benefit to women without symptoms. Find out if and when you need a pelvic or PAP exam below. After all, no one likes having to do this!
Wait, what?! No More Pelvic Exams?
Pelvic exams have been one of the pillars of the adult female GYN exam for decades. But the truth is, pelvic exams rarely detect hidden diseases (such as ovarian cancer). In fact, according to decades of studies, doing a pelvic exam does not reduce mortality even if something were found.
It is imperative that women recognize that getting a PAP every 3 years is still absolutely beneficial and necessary. But routine pelvic exams are not.”–Dr. Michael Freedman of Evolve Medical.
Pelvic exams can find endometriosis, ovarian cysts, uterine fibroids, warts, herpes, pelvic inflammatory disease, and cervical polyps. But research has not shown that detecting and treating these before they produce symptoms is better than waiting for early symptoms to appear, according to Dr. Amir Qaseem, of the ACP.
Pelvic exams can also cause harm. Up to 46% of the time what the provider finds is a “false-positive” (finding something that isn’t really there.) For example, when a doctor thinks they’ve found ovarian cancer, the chance that the woman actually has it is only 0-3.6% (in other words, 97-100% wrong). But once the doctor tells you you might have ovarian cancer, not only are women understandably terrified but they then will undergo sometimes risky tests, biopsies and even surgery all to figure out it there was never anything there in the first place.
Pelvic exams can also give false reassurance. When an exam finds no sign of ovarian cancer, for instance, there is a chance the woman actually has it, according to studies reviewed by the task force. Such “false negatives” can cause a woman to ignore early symptoms of a potentially deadly disease.
PAP Tests: Still Need Them (every 3 years)
It is very important that women understand the difference between a “pelvic exam” and a “pap smear”. Pelvic exam is done to detect ovarian or uterine cancer and PAP smear is done just to detect cervical cancer. The CDC has published a summary of all the different recommendations which are summarized below.
Pap testing should begin at age 21 and occur every 3 years until a woman is 65 years old. At 65 and up, if the PAPs have been negative, there is no indication for any kind of routine PAP or pelvic exam ever again.
For women ages 30-65, HPV should be tested every 5 years. Women under 30 should NOT be tested for HPV.
What About Ovarian Cancer?
According to the CDC, “There is no simple and reliable way to screen for ovarian cancer in women who do not have any signs or symptoms.” Unfortunately, none of the governing bodies recommend screening for ovarian cancer because the available tests (pelvic exam, ultrasound, blood test for CA-125) are all unreliable.
The CDC goes on to advise “Pay attention to your body, and know what is normal for you. If you notice any changes in your body that are not normal for you and could be a sign of ovarian cancer, talk to your doctor about them.”
The signs and symptoms of ovarian cancer are the following:
- Vaginal bleeding or discharge from your vagina that is not normal for you.
- Pain in the pelvic or abdominal area (the area below your stomach and between your hip bones).
- Back pain.
- Bloating, which is when the area below your stomach swells or feels full.
- Feeling full quickly while eating.
- A change in your bathroom habits, such as having to pass urine very badly or very often, constipation, or diarrhea.
So what is the final answer? You should continue getting your PAP every 3 years (unless you are over 65, then you are done).
And you should still be seen by your Primary Care once per year. Although there is a lot of debate as to whether the annual “physical exam” is of benefit, Dr. Freedman of Evolve Medical, has this to say:
“I find it an important time to review vaccines, screen for high blood pressure, cholesterol and diabetes, in particular. Is this person up to date on mammogram, colonoscopy, PAP? It’s the time I use to counsel people on healthier lifestyle choices (exercise, nutrition, weight). And I think it’s important, once a year, to update a person’s medical chart with any new procedures, surgeries, tests or diagnosis that has been made during the previous year.” Dr. Freedman feels the bottom line is this, “I feel that at least once a year, we need a visit that is just focused on preventative measures.”
If you have any questions or have been experiencing any of the above symptoms, see your primary care physician immediately or visit Evolve Medical. Same day scheduling on-line here or call 844-322-4222. Or email them at [email protected].