If you go to your doctor’s office and get told to not come back for a pap smear in 1 year or 3 years or 5 years…. this may be an appropriate recommendation according to the pap smear guidelines, (based on pap smear history, risk of cervical dysplasia, age and history of human papilloma virus- HPV) but not the same as annual well-woman gynecologic health assessments. Our yearly visit is not dependent on receiving a pap smear or not. The yearly visit can identify disease risks, current medical problems, optimize prevention strategies, discuss lifestyle issues (nutrition, exercise, smoking, alcohol, stress) and establish a good working relationship with your clinician.
I was glad to see that The American College of Obstetricians and Gynecologists (ACOG), recently updated their guidelines for well-woman gynecologic visits.
Major recommendations include:
- The first gynecologic visit should occur between age 13 and 15 and should emphasize education (body image, weight management, immunizations)– I would add, nutrition, exercise, avoidance of smoking and alcohol)
- Pelvic examinations are not necessary to test for sexually transmitted diseases or to initiate oral contraceptives in healthy, asymptomatic testing. Currently, even a urine sample can test for common STDs and a blood test can test for herpes simplex.
- Annual examinations of the external genitalia should be performed in all women; complete pelvic examination is recommended for all women 21 years and older. Internal examinations (visualizing the cervix and internally palpating the uterus and ovaries) can be made jointly by clinician and patient with discussion and information.
- Annual pelvic examination is not necessary in healthy, asymptomatic women who have undergone a hysterectomy and removal of both ovaries if that surgery has been done for non cancerous and non pre-cancerous issues, and the woman has no history of a genital tract neoplasia or in women because of health status or age, would choose not to act even if abnormalities were discovered.
- Clinical breast exams by the practitioner are recommended annually, despite a lack of clear evidence of benefit.
It is reassuring to know that ACOG has addressed this issue of well-woman gynecologic exams as too many women and even too many practitioners, end up not receiving/advising these visits other than when done on pap smear intervals. It is important for all to realize that the “pap smears” and “well-woman visits/pelvic exams” are not synonymous. Furthermore, The Affordable Care Act mandates insurance coverage of yearly well-woman visits.
Committee on gynecologic practice, the American College of Obstetricians and Gynecologists. Committee opinion no 534: Well-woman visit. Obstet Gynecol 2012 Aug; 12:421.