Gynecology Q & A

Happy Asian woman

Why are regular gynecologic exams important?

Gynecologic exams are an ideal time to ask questions and talk about your concerns about sexual health, fertility, pregnancy, menstruation, hormones, sleep, mood, menopause, and more. The physical exam components (i.e., breast and pelvic exams) are important for identifying diseases and certain medical conditions, including sexually transmitted diseases and cancer, in their earliest stages, when they're most treatable. Ideally, you will have a pelvic and/or breast exam with a provider who takes the time to ensure your comfort with the exam, provides quality education, and answers all your questions without embarrassment or judgment. Having regular exams when there is nothing "wrong" can give you valuable knowledge and confidence about your amazing body. It also helps your provider to know what is normal for you, so that when your body shifts or problems arise, we know your baseline. Most of us lack confidence when it comes to our intimate bodies, and it is common to wonder, "am I normal?". Having regular breast and pelvic exams with a respectful and sensitive provider can give you that vital confidence to learn to know your own "normal". Not only does this provide empowerment, but it ensures that you will be able to spot subtle changes in your breast or pelvic organs and seek treatment at the first sign of a problem. Our breast and pelvic organs often suffer from neglect because we aren't encouraged to learn about healthy breast and pelvic physiology. Having these regular exams is a great way to ensure that you have all the information you need to be able to make smart choices about your intimate and sexual health throughout your life.

What can I expect during my exam?

During your visit, Jill will first sit and talk with you about any specific concerns and review your health history before your exam. Then she will record your blood pressure and weight, look at your eyes, ears, and skin, and feel your throat and abdomen for any masses or tender spots. She will perform a clinical breast exam – a critical tool in identifying early-stage breast cancer. If you need a pelvic exam, she will carefully and thoroughly examine your external genitalia using a painless method called vulvoscopy. If an internal exam is needed, she will use a speculum to examine your vagina and cervix. If the speculum is uncomfortable for you, Jill will help you to find a position and a method of examination that allows you to relax as much as possible. During the internal exam, she may collect a sample of cervical cells with a soft brush, also known as a "pap smear", to screen for cervical cancer. She may also take a sample of vaginal fluid to look for vaginal imbalances or sexually transmitted diseases. Collecting samples for analysis is a quick and generally painless process. Depending on your symptoms, to conclude your internal exam she may also gently palpate your internal organs and pelvic muscles to diagnose specific pelvic conditions.

How often should I have a pelvic exam?

Currently, the American College of Obstetricians and Gynecologists (ACOG) recommends women have pelvic exams only when they have symptoms or have a medical history that requires it. ACOG acknowledges that, despite rigorous research, there is not much evidence demonstrating the usefulness of annual pelvic exams for women who aren't pregnant, experiencing symptoms, or at risk for gynecological conditions.  This means that you only need a pelvic exam if there is something that you are concerned about, such as irregular bleeding, pain, abnormal discharge, or other concerning symptoms.

Why is it called an "annual exam" if I do not need a pelvic exam every year?

Even if you don't necessarily need a pelvic exam, there are several reasons why gynecologic providers continue to recommend an annual exam. First, The American College of Obstetricians and Gynecologists (ACOG) and the American Cancer Society still recommend annual breast exams, which are an important component of the gynecologic exam.

Second, it is an unfortunate fact that many primary care providers are uncomfortable and/or inexperienced at discussing periods, sexual function, hormones, and mood with female patients. Many medications and treatments for non-gynecologic concerns (i.e., depression, bacterial infections, allergies) can have side effects that impact your sexual and reproductive health. It is incredibly common for these impacts to be dismissed or overlooked in primary care settings, which can diminish our trust in the healthcare system. It is important to develop a relationship with a gynecologic provider who is skilled in these areas, to ensure that you have access to expert advice and guidance when it comes to your sexual and reproductive health.

Thirdly, many women remember a time when it was "required" to have a pelvic exam every year, regardless of symptoms. Up until 2014, the ACOG and the American Cancer Society recommended pelvic exams and Pap smears every year, regardless of age or risk factors. This recommendation changed in 2014 when researchers finally determined that annual pelvic exams without a medical indication caused more harm than good.  The decision whether to have a pelvic exam should therefore be a shared decision between you and your provider at every visit, and it is certainly not "required" anymore unless there is something that you or your provider are concerned about.

The current recommendation for Pap smear cancer screening varies according to your age and your individual risk factors. At Quantum Women's Health, if you need a pap smear, Jill will always call or email you your results directly, and at that time she will also give you a specific recommendation about when your next screening is due, based upon ASCCP Risk-Based Management Consensus Guidelines.