Annual gynaecological examinations, pap smears and STI screenings are not exactly something to look forward to – they are often uncomfortable, time-consuming and expensive.
About a month ago the American College of Physicians (ACP) released new guidelines, stating that a routine annual pelvic examination is not necessary in non-pregnant women without any symptoms. In response to this the American College of Obstetrics and Gynaecology (ACOG) stated that they continue to stand by its guidelines, urging women to visit their doctor for annual visits.
Before we can decide who to listen to we need to understand what a gynaecological examination entails. A gynaecological exam consist of four components, pelvic exam, Pap smear, STI screen and breast exam.
Pelvic exam: During the pelvic exam, your doctor checks your sex organs. Starting on the outside, your doctor will inspect the external genitalia, urethral opening, vaginal opening and the perianal region. After the external examination your doctor will insert a speculum inside the vagina to exam the vagina and the cervix. To complete the internal examination a bimanual examination will be done. Your doctor will check your uterus by placing a finger in your vagina while gently pressing on your stomach.
Pap smear: A pap smear is a screening test for cervical cancer. This is usually performed during the speculum part of the pelvic exam. Cells of the cervix is scraped from the surface and sent to the laboratory for investigation. Pap smears can not only detect cancer cells but also pre-cancerous cells which can be treated to prevent cancer.
Cervical cancer is the most common cancer of women in the African continent. The link between cervical cancer and the human papilloma virus (HPV) has been well established. Women who have been affected with certain types of HPV and have not been able to clear the virus can get cervical cancer and precancers. The first Pap smear must be done at the age of 21 years (irrespective of sexual activity) or within the first three years of onset of sexual activity. Thereafter smears should be taken every three years.
Don’t forget about the HPV vaccine.
STI screening: This is not a standard part of the annual gynaecological exam. Since SA has the highest number of people living with HIV and other STI’s are common but often asymptomatic, we routinely add a STI screen to anyone who is sexually active according to the World Health Organisations recommendations.
Breast exam: Your doctor will gently palpate your entire breast, your armpit to just below your breast. This is done to identify any abnormal breast lumps or masses. Guidelines recommend that a breast exam be performed annually from the age of 40 years.
A pelvic sonar (ultrasound) is not part of the routine gynaecological examination. It drives up cost and are often done unnecessarily. A sonar is a special investigation that should only be done if indicated, when pathology is suspected.
Ok, let’s get back to the question. Do I really need an annual gynaecological examination? YES! The ACP says that an annual pelvic examination is not indicated, but that is only one part of the entire gynaecological exam. I agree with the ACOG, a yearly visit to a gynaecologist to cover all of the above is a “fundamental part of medical care and is valuable in promoting prevention practices, recognizing risk factors for disease, identifying medical problems, and establishing the clinician–patient relationship.”
It is not necessary to see a gynaecologist to get your routine check-up, your GP can do it and refer you to a gynaecologist if he/she finds any abnormalities.
We are sexual health doctors and offer all of the above mentioned aspects of a gynaecological examination at our clinics in Pretoria, Johannesburg, Witbank and Cape Town. We work in close conjunction with gynaecologists and various other specialists in cases where surgery, major interventions and second opinions are necessary.
We often see women who are terrified of pelvic examinations and women who are still virgins. It is our aim to make patients feel at ease and to make the experience as positive as possible. Give it go – it might not be as bad as you think…
After all, it is the month of August, National Women’s month, let’s book your annual visit today.
