My office has a strict policy requiring patients to come in for an annual gynecological exam before receiving a refill on their hormonal birth control. This made sense when we were doing Pap smears every year, but now that the American Congress of Obstetricians and Gynecologists (ACOG) has changed Pap guidelines, is this an antiquated practice?
Since late 2009, ACOG has recommended that in the absence of risk factors, women aged 21 to 30 years should have Pap smears performed every two years and every three years for those aged 30 years and older. There is no official guideline on how frequently pelvic exams should be performed, but for obvious reasons, the two practices usually go hand in hand.
Hormonal contraception and the pelvic exam have also become permanently linked, and many providers refuse to prescribe this form of birth control without an exam.
Many of my patients would be thrilled not to endure their annual visit to the gynecologist. It is not a particularly pleasant experience. In my opinion, young woman seeking contraception should not be required to have a pelvic exam before receiving their prescription.
But to me, the value of an annual women’s health visit goes beyond the pelvic exam and Pap smear. It also includes a breast exam, a skin check and an opportunity to screen for STDs and thyroid issues. The CDC still recommends annual screening for chlamydia and gonorrhea in women aged 25 years and younger.
This is also the time to discuss sexual health, provide general health education and promotion, and offer anticipatory guidance for events like sexual debut, conception and menopause. For many of my patients, their annual gynecological exam is their only encounter with a health-care provider.
And while women on hormonal birth control may not require a yearly Pap smear or a pelvic exam anymore, it is still important that they have their BP checked before getting a refill for another year.
On the flip side, there are many women who insist on having an annual pelvic exam and Pap smear, despite understanding the rationale behind the latest recommendations. They feel better with a thorough yearly exam, even though they may not really need one.
Some argue that pelvic exams on asymptomatic women are useless and serve no purpose. Benign findings such as small fibroids or ovarian cysts are common, and can lead to unnecessary intervention. However, I cannot help but wonder if we stop doing routine pelvic exams, will litigation increase for missed malignancies of the reproductive organs?
Although annual Pap smears and even pelvic exams may soon become a thing of the past, I think it is important not to diminish the importance of annual gynecological visits for women from adolescence through menopause.
Robyn Carlisle, MSN, CNM, WHNP, works as a full-scope midwife at University Doctors and Kennedy University Hospital in Sewell, N.J.