Do you need an Annual Pelvic Exam?

There are two parts to an annual pelvic exam. The first is the speculum examination in which a speculum is inserted into the vagina to visualize the vulva, vaginal tissue and cervix. Tests of the cervix can be done at that time. The speculum is removed and the doctor does a bimanual examination, in which the ovaries and uterus are palpated with one hand on the abdomen and two fingers inside the vagina. Both tests are good to have, whether or not you have a uterus or cervix. But should it be required on an annual basis as part of an annual examination?

These tests are currently done as screening tests for chlamydia and for gonorrhea, in preparation for giving oral contraceptive medication, to screen for cervical cancer or to detect ovarian cancer or uterine size. If doctors eliminate the bimanual examination in asymptomatic patients and limit speculum exams to those who have symptoms, costs of the gynecological examination can be reduced without obvious detriment to patients.

On the other hand, screening for chlamydia can cut down on asymptomatic infertility and pelvic inflammatory diseases. Newer tests using self administered swabs are available. The newer tests are cost-effective and are sensitive enough to be as sensitive as a speculum examination if doctors choose to use or recommend them.

Surprisingly, the requirement of pelvic exams before hormonal contraception has never been shown to be necessary. The possibility of a pre-existing pregnancy can be ruled out with a blood HCG test, which is much more sensitive than a bimanual examination. Most organization no longer require a pelvic examination for a prescription of hormonal contraception.

Cervical cancer screening is a good reason to have a speculum examination and pap smears have been shown to reduce the morbidity and mortality from cervical cancer. Such tests begin at the age of 21 and are done every two to three years thereafter until a person reaches the age of about 70 years. On the other hand, there is new technology that will detect cervical cancer without a pelvic exam/speculum examination.

Ovarian cancer is difficult to diagnose and bimanual examinations do not detect ovarian cancer very well. The cancer has to be significant to be found on any kind of bimanual exam.