Why have physicians done pelvic exams on healthy women annually for decades? Those who cling to this invasive, unpleasant procedure justify doing so for four reasons.1.) Screening young women for sexually transmitted disease (STD). This is an evidence-based intervention, but screening can now be done on a urine sample or self-administered vaginal swabs. STD screening is not a reason to do a pelvic exam.2.) Evaluation prior to prescribing birth control pills. For years physicians wouldn't prescribe oral contraceptives without a pelvic exam. It was a major barrier for many young women to getting the contraceptives they needed. Now all women's health guidelines agree that a pelvic exam is not required before prescribing "the pill."3.) Pap smears have proven effective in decreasing the illness and deaths from cervical cancer. Current recommendations now are not to start screening until women are 21 years of age.Furthermore, in women with normal pap smears, screening (and the associated pelvic exam) should occur only every 3-5 years. Finally, if you have had a hysterectomy and do not have a history of cervical or vaginal cancer, you never need another pap smear! In the works: A technology that allows a pap smear without a pelvic exam.4.) Screening for ovarian cancer. All authorities now agree that the pelvic exam is a useless screening tool for ovarian cancer.Like lots of screening tests, pap smears are fraught with false positives and repeat testing that is often non-productive.Due for your annual exam soon? Ask your physician whether you really need a pelvic exam this year.Dr. Mohler has practiced family medicine in Grand Junction for 38 years. He has a particular interest in pharmaceutical education. Phil works part-time for both Primary Care Partners and Rocky Mountain Health Plans.
MOHLER: Swear off the stirrups
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