Let’s Clear the Air

I wanted to clear the air on a health maintenance topic that has become increasingly more puzzling and complicated to the practice of medicine. One managed Care Company and several patients alike have asked the question: Are annual gynecologic visits really necessary?

My answer (echoed by almost every gynecologist who is up to date on current guidelines) is an ardent: YES!

The performance of the Pap smear at the time of the annual exam is part of the confusion.

For most patients, getting undressed and having a pelvic exam is synonymous with a "pap smear".  Even though the pelvic exam and the Pap smear are frequently done together, they are not the same.

The pelvic exam is a complete examination of the external genitalia & groin region. Furthermore a pelvic exam may identify other pelvic pathology not attributed to a gynecologic source. 

On the other hand, the Pap smear is a screening test whereby a small plastic spatula and brush are used to exfoliate cells from the cervix and determine if they are normal or part of a disease process, notably infection with the Human Papillomavirus (HPV).

Despite the recommendation to have a yearly gynecologic exam, Pap smear guidelines have changed. This has led to the assumption that since a yearly pap is not needed; one does not need to see her gynecologist yearly. 

However, there are several reasons to see a gynecologist annually: 

  • assessment of current health status including height, weight, & blood pressure; nutrition; exercise; sexual practices & function     
  •  tobacco & alcohol screening & counseling    
  • contraceptive management    
  • mental health screening
  • screening for gynecologic infections; immunizations
  • breast exams
  • bone health      
  • menopause & hormone management
  •  & the 'above pelvic exam' & possibly a pap smear.  

     The American Congress of Obstetrics and Gynecology, an organization of women's health professionals that develop practice guidelines based on evidence-based (research based) studies, submitted a set of updated guidelines earlier this year.  In terms of beginning the annual gynecologic encounter, the recommended age is 13-15 years old.

This encounter will focus on current health status, counseling, screening, and preventative services.  Unless symptoms or risk factors warrant it, an internal pelvic exam is generally not necessary, nor is a pap smear for cervical cancer screening.  

The internal pelvic examination and breast examination usually begin at age 19 and continue as part of the comprehensive annual gynecologic exam.  Current recommendations for Pap smear screening are initiated at age 21 and every 2 years thereafter until age 30 if Pap smears are normal.  

At the age of 30, women may have Pap smears every 3 years if they have had 3 consecutive normal Paps or if they have a normal Pap smear and negative HPV test.  Again this schedule is only appropriate if Pap smears are normal and there are no other risk factors present which may require more frequent screening Paps or other evaluation.  

Also, as mentioned above women still should see their gynecologist annually regardless of whether a pap smear will be performed for the above mentioned assessments.

To simplify matters, all a woman needs to remember is to see her gynecologist at least one a year for the 'Annual Well Woman Exam" and the physician will determine what examinations, tests, and counseling to perform if necessary.

These determinations will be made by one of our board-certified or board-eligible practitioners who constantly strive to remain up to date on the cutting edge of women's health care.  

So remember-mark your calendar ONCE a year to see your favorite gynecologist... It's important. Your body will thank you.

 

Posted on December 8, 2011

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