I am often compared with the dentist as the most dreaded appointment people face. Visiting the gynecologist or dental work, which do you dislike the most? Since I have been on both sides of the speculum, of course, I know why women dislike it. But it doesn’t have to be that way.
As you should know, screening guidelines have changed. For women over 30, you should get both a pap smear and an HPV test. If your Pap smear is normal and HPV negative you only need that test once every five years. Yes, that’s right, five years. We are still working on the interval, and I think five years may end up being too long. But that’s what the guidelines say.
Chance are you don’t need a pap smear, but do you need a pelvic exam? Women often think of the pap smear as synonymous with a pelvic exam. The Pap smear is a sampling of cells on the cervix that is a screen for cervical cancer, and only cervical cancer. It is just one part of the pelvic exam. The other significant part is the bimanual or internal exam. What about that? If I don’t need a pap smear every year do I need a pelvic exam? The answer according to the American College of Obstetricians and Gynecologists (ACOG), is yes. The following is a quote from their committee opinion on well-woman visits.
The College guidelines recommend that a pelvic examination be performed on an annual basis in all patients aged 21 years and older. No evidence supports or refutes the annual pelvic examination or speculum and bimanual examination for the asymptomatic, low-risk patient. An annual pelvic examination seems logical, but also lacks data to support a specific time frame or frequency of such examinations. The decision whether or not to perform a complete pelvic examination at the time of the periodic health examination for the asymptomatic patient should be a shared decision after a discussion between the patient and her health care provider.
Pretty lame, huh? They’re saying do it every year because it seems logical, but there is no evidence to support it. I would argue that it is in fact harmful. It finds stuff that needs follow-up but rarely improves outcomes. I tell my patients this that my professional association, ACOG, recommends a pelvic exam annually. But there is no evidence to support it if you are asymptomatic, and it’s up to you to decide. How many pelvic exams do you think I do? Yeah, that’s right, none.
If you have concerns, that is a different story. Then any findings might be meaningful. But for an asymptomatic person, I don’t think it makes any sense. It does not provide any useful information. It is not logical.
I am critical of radiologists who always seem to be the ones who most vociferously recommend annual mammograms. Radiologists have a clear financial interest in women getting more mammograms. I think this is the same kind of thing. Gynecologists have a financial interest in annual pelvic exams.
You don’t need a pap smear, and you don’t need a pelvic exam every year. Awesome. Should you still see your gynecologist regularly? At the risk of seeming like those radiologists, I think the answer is yes because the real reason to see your GYN is not for screening tests. Our medical system puts too much emphasis on screening test as it is. What’s really going to help your overall health and longevity is your habits, your lifestyle. A study published in 2009 in the Archives of Internal Medicine revealed that four healthy behaviors- never smoking, maintaining a normal weight, exercising and eating a healthy diet- can reduce the risk of the most common and deadly chronic diseases but as much as 80%.
A Pap smear and a pelvic exam are never going to improve your health outcomes by that much. I think we all have health goals that aren’t always being met. I can help you with that. There so much health and wellness information coming at you every day, I’d be surprised if you didn’t have questions. And right now under the ACA, you are entitled to one preventative health visit every year which is 100% covered by insurance.
Many of you would like to lose weight, be healthier and more fit. I can help you with all of that. Are you feeling your best every day? If not, I can help you with that. Common problems include digestive issues, fatigue, just not feeling as well as you used to. Maybe it’s ‘adrenal fatigue’ or maybe it just fatigue- your not getting enough sleep. Maybe you’re sensitive to gluten, or maybe it’s a toxic relationship or other stressful situation that’s causing your digestive distress.
I staunchly believe in mind-body medicine. I believe you can heal yourself and I don’t think you need a fistful of daily, expensive supplements to do it. Basic lifestyle medicine can resolve many if not most problems. In the words of Dr. David Katz lifestyle medicine has six components: feet, forks, fingers, sleep, stress, and love. Feet refers to exercise, forks is a plant-based diet (doesn’t have to be vegan,) and fingers relates to tobacco use. Sleep, stress, and love should be self-explanatory.
I include purpose on that list.
When your life contains an element in each of these areas, it will add up to the kind of life you want to be living. Not only will you feel well, but you will also be healthy and prevent chronic disease. Establishing and then maintaining healthy habits in these areas can be hard. And perfection is not your goal. Instead of reducing stress, wellness practices have become a potential source of stress as there is always something else you should be doing. Women often end up creating more stress in their lives around things that should be reducing it.
Your annual visit to the gynecologist does not have to be something you dread. Instead, it can be time to talk about yourself and collaborate about your health, which should be fun. My job is not to berate you for eating junk food, not meditating or sleeping next to your phone. I do (or do not do) those things. My job is to help you live your best life, be all you can be. The best part of my job is discussing your health now, answering your questions and helping you make healthy choices. This discussion is the most important part of your ‘annual exam” and maybe all you need. I also provide ongoing advice and support, to help you meet your health goals. For that, I see you on a regular basis.