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Do You Really Need a Pelvic Exam?

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If you feel like it's impossible to keep track of health screening recommendations, take heart: Even doctors can't seem to get them straight. When a primary care physician is asked if a patient without any symptoms needs an annual pelvic exam—which examines your urethra, vagina, anus, cervix, uterus, and ovaries—she says no; when an ob-gyn is asked, she says yes, reports a recent study in Annals of Internal Medicine

What gives? Well, an American College of Physicians review last year suggested pelvic exams don't benefit you if you don't have any symptoms and can lead to often unnecessary and expensive tests. On the other hand, the American College of Obstetrics and Gynecology maintains the stance that the annual exam is a fundamental part of a woman's medical care.

To make matters even more confusing, recommendations have changed in recent years regarding pap smears (you know, that oh-so unpleasant swab of your lady bit—one part of the traditional pelvic exam). The test used to be performed annually, but now some low-risk women can wait three to five years between cervical cancer screenings.

So what should you do? Well, that kind of depends on your relationship with your ob-gyn. About 44 percent of preventive care visits are to an ob-gyn, according to a study in JAMA Internal Medicine, which means many women use their ob-gyn as their primary care physician. (Don't forget to bring up these 13 Questions You're Too Embarrassed to Ask Your Ob-Gyn.) So if you skip your annual exam, that could cheat you out of important opportunities to discuss your health with your doc, says Nimesh Nagarsheth, M.D., an associate professor of Obstetrics, Gynecology, and Reproductive Science at the Icahn School of Medicine at Mount Sinai in New York City.. "If I'm examining a patient and I see a reddened or irritated area, I can ask, 'Has this been bothering you?'" he says. "Suddenly, it opens a whole dialogue. That's one of the benefits of examining a patient, it improves communication."

Other benefits: If your ob-gyn is your primary care doc, keeping a yearly visit will keep you up to date with health screenings such as blood pressure and other vitals, he says.

Nagarsheth says that suggesting women skip annual pelvic exams is disheartening. "We've put so much effort over the years into creating more awareness and dialogue about gynecologic cancers," he says. "I'm concerned that if doctors start eliminating the annual pelvic exam, women may receive the message that symptoms pertaining to that part of their body aren't as much of a priority as they should be," he says.

The bottom line: If you have any symptoms—pain, irritation or irregular bleeding, for example—see your doctor (and don't wait for your annual). And whether or not you have symptoms, continue seeing your primary care physician or your ob-gyn on the regular. Consider keeping your annual pelvic exam too. "While there's concern that we're doing too many exams and they can lead to unnecessary testing and procedures, skipping them altogether can backfire," Nagarsheth says. (Plus, if you're worried about excess testing, just be aware of these 3 Doctor's Orders to Question.) And know this: Nagarsheth says not detecting serious issues such as cancers, means they have an opportunity to advance, becoming harder to treat, and potentially more deadly.

Better safe than sorry.

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