Letter to the Editor: Please Don’t Skip Your Annual Exam
As a practicing gynecologist in the Louisville area, I would like to respond to the September 2nd Courier-Journal opinion article questioning the value of women’s annual gynecologic exam. While it is true that various health-related organizations disagree as to the value of certain screening tests, the majority of us who focus our medical practice on wellness for women can attest to a huge value gained with the annual gynecologic exam. I remember well being nervous about my own first gynecologic exam as a teenager. My mother’s OB/GYN, Dr. Cecil Grumbles, gently reassured me. He let me know that he could help my horrendous cramps that were causing me to miss school once a month. I had just assumed that bad cramps were to be part of my life, but he not only made my life better (and my grades), my experience inspired me to consider the field in which I am now privileged to practice.
Most medical organizations agree that for women at low risk for cervix cancer, the pap smear test (as a separate screening test) can be performed less often than yearly. However, the American Congress of Obstetrics and Gynecology (ACOG) staunchly defends the need for a yearly well-woman exam after age 21 that will generally include a breast and pelvic exam. ACOG does add, “The decision to perform any type of pelvic or breast examination should always be made with the consent of the patient.” Most of my patients expect to be examined, as they want the reassurance that all is well…and it isn’t always.
Often disease processes, and opportunities to prevent disease, are not preceded by symptoms. For example, just last week I diagnosed and treated a young woman for three different STDs for which she had no symptoms; informed another that she will need minor surgery in order to have sex; counseled several women on evidence of early pelvic floor prolapse and how to prevent it from worsening; diagnosed and treated many cases of atrophic vaginitis (loss of lubrication and elasticity) and urethral atrophy—conditions that can cause vaginal pain as well as lead to urinary and kidney infections. I also counseled patients about sexual dysfunction, the “biologic clock,” preconceptual planning, and menopause.
The physical exam was integral to these encounters. These examples do not include my patients that actually had symptoms; in other words, these were women I saw last week who are now being advised that they may not need an annual gynecologic exam.
Other important elements of the annual well-woman wellness visit may include:
I caution every woman to protect the relationship with your health and wellness care provider, and at its core is the regular annual physical and gynecologic exam. The Affordable Care Act began its push to guarantee coverage for an annual exam for all adult women in 2012; it is now protected with no co-pay or deductible application for most healthcare plans.
Some advisory panels target specific conditions and then use converse logic to draw conclusions that may not be the best for the individual patient. To quote the Courier-Journal’s own Bryant Stamford’s recent article defending the benefits of flossing teeth, “There are no published research reports that conclude keeping your eyes open while driving is better than keeping them closed…. As a result the headline would be, ‘No need to drive with your eyes open.’”
If this is the sort of logic that the United States Preventive Task Force is using, it might save money spent on women’s health screening in the short term. But in the long run, this kind of recommendation is not what is best for women. Please continue to come in for your annual exam—we want to take good care of you and help you take care of those that depend on you.
Rebecca Booth, MD, FACOG