By MICHAELEEN DOUCLEFF (NPR) June 30, 2014 6:34 PM ET
The American College of Physicians said Monday that it strongly recommends against annual pelvic exams for healthy, low-risk women.
In fact, the intrusive exams may do more harm than good for women who aren’t pregnant or don’t have signs of problems, a group of doctors wrote in the Annals of Internal Medicine.
When we heard that news here at Shots, we were happily surprised. No more stirrups? No more stripping down below the waist or hearing those dreaded words: “Now, you’re going to feel a little pressure”?
Sounds great! I’m canceling my annual visit now.
Not so fast. Not all doctors agree about these new guidelines…
(For entire story: http://www.npr.org/blogs/health/2014/06/30/326703530/skip-the-stirrups-doctors-rethink-yearly-pelvic-exams)
Don’t cancel your regular visit with your gynecologist. If you are healthy and without symptoms, you can see your doctor every 2-3 years rather than annually, though. Many women use their gynecologist as their only primary care physician. The conscientious and thorough gynecologist can be just as effective and knowledgeable as an internist or family physician. Better yet, many non-gynecologist physicians have no clue how to perform an adequate gynecological examination or a Pap smear or even a rectal examination!
As a physician who performs many annual physical examinations, let me let you in on some professional “secrets”:
1. The likelihood of finding a serious medical condition during a physical examination on a patient without symptoms (asymptomatic) is incredibly low.
2. The most important aspect of a periodic examination of an asymptomatic patient is in educating her about preventive care and inquiring about family history of serious illnesses rather than finding a serious medical condition.
3. The physical examination’s most important aspects are blood pressure, weight (and BMI), examination of the skin, thyroid, breasts, pelvic (and Pap smear where necessary), and rectal examination (when necessary). The rest (including head, neck, lung, heart, abdomen, and extremities) is simply less important in asymptomatic patients.
4. So, if you are an asymptomatic, healthy female, skip your internist or family medicine physician (unless you find one that can perform an adequate examination below the belly button…) and see your gynecologist (unless he/she do not adequately address preventive medicine issues and do not examine you above the belly button).
5. During an examination, I always examine the neck and abdomen, and listen to the heart and lungs in addition to the more crucial elements (thyroid, skin, breasts, pelvis) despite extremely low likelihood of finding anything of importance in a healthy, asymptomatic patient. When you professionally and tactfully apply the hand touch, patients often feel reassured that their physician is both thorough and caring.
6. There is a famous story about a physician who owned a horse. Being a true scientist, and tight in the pocket, he decided to gradually reduce the horse’s feed (wishing to save on expenses and relying on the lack of scientific evidence that a certain amount of feed is vital for his horse’s survival.) The program worked elegantly, but then the horse died… I personally would feed this horse a regular diet and skip the psuedo-scientific, misguided advice of the American College of Physicians…