"Put your feet in the stirrups and scootch your butt all the way down. Further down. Little further. Now, try to relax." These are the instructions that usually accompany the routine, often dreaded, pelvic exam that is de rigueur for most gynecological checkups.
Some women are resigned to this exam, others find it embarrassing and unpleasant, and still others may detest it so much they avoid seeking gynecological care in order to skip it -- but what if it wasn't always necessary?
What if women could safely go for two or three years, granted they were healthy and without symptoms of disease, without the hassle?
That is precisely what a commentary published in the January edition of the Journal of Women's Health is suggesting: In healthy, asymptomatic women, a pelvic exam doesn't have to be done yearly, and in women under 21, perhaps not at all. And many gynecologists feel that this assertion has been a long time coming.
Authors of the commentary argue that many of the reasons pelvic exams are employed today are unnecessary and could be replaced by less invasive techniques. The evidence suggests that less frequent pelvic examinations have no detrimental effect on health outcomes in everything from testing for STDS to prescribing hormonal contraceptives to screening for gynecological cancers.
The authors' arguments "are completely valid," says Dr. Diane Harper, director of the Gynecologic Cancer Prevention Research Group at the University of Missouri-Kansas City. "There are so many other health needs, including behavioral medicine, depression, coping skills, domestic violence, etc., that need to be addressed in the time that we used to do pelvic exams."
The American Congress of Obstetricians and Gynecologists is taking this issue to heart.
"It's something that's on their plate for discussion to have possibly new recommendations for the annual examinations in the near future," says ACOG representative Dr. Jessica Shepherd, a Louisville, Ky. based gynecologist. "The reason this is being addressed is that when we look at pelvic exams historically, they have just not been linked to an increase in diagnosis of things like ovarian cancer."
The commentary lays out all the reasons a pelvic exam might be employed in women who otherwise show no symptoms of gynecological issues and then, citing studies and industry guidelines, explains why most of these situations actually do not require such an exam.
A pelvic exam is usually done in order to take a Pap smear, a test that samples cells on the cervix to check for signs of cervical cancer, as part of the examination before prescribing birth control pills or the ring, and to check for signs of uterine or ovarian cancer. This last test is done with a bimanual examination -- two fingers are inserted into the vagina while the other hand presses on the abdomen in order to feel for abnormalities, cysts or fibroids.
In most of these situations, however, a pelvic exam is either irrelevant, ineffective, or needed less frequently, the study authors say.