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More Important Information About Pelvic Exams

11 August 2016

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Our recent pelvic exam post on I On Your Health got many readers talking, and we received quite a few questions. Here is another post from Dr. Courtney Seacat with answers.

Should women who have had a hysterectomy still have an annual pelvic exam?

Any patient with a complete hysterectomy (which means she no longer has a cervix) for benign reasons (meaning: not cancer) and without a history of abnormal pap smears no longer needs a pap smear.

BUT! I still recommend yearly pelvic exams to look at the external part of the vagina and vulva, and an internal exam if you have ovaries and to make sure there are no masses or pain. Side note on Pap smears: if you've had an abnormal Pap smear in the recent past, or certain types of cervical dysplasia uncovered in previous years, I still recommend getting a Pap smear even if you've had a hysterectomy. In that case it's best to talk to your doctor, who will tell you if you need a Pap smear or not.

Should women who are post-menopausal still have an annual pelvic exam?

Yes! After a hysterectomy or menopause, there are still so many aspects of women’s health to be evaluated. The likelihood of cancer increases with age and problems are often found first through annual exams. In post-menopausal women who have had nothing removed, we need to evaluate for post-menopausal bleeding, or evidence of masses on the uterus, cervix and ovaries.

What about women who are over the age of 65? When can they stop getting pelvic exams?

For women over 65, with no history of abnormal Pap smears in the last 20 years, they can stop getting Pap smears. However, I still recommend regular external pelvic exams to look at the vagina. Also, if a woman over 65 still has her uterus or ovaries, I recommend regular internal exams, too.

The time to stop having a pelvic exam is an individual decision between the patient and her physician, and depends on that patient's history and issues. No person is the same, so women who are sexually active into their 70s and 80s still need exams and may have vaginal concerns that need to be addressed.

Really, the whole point is to have someone regularly examining the vaginal area, no matter the woman's age. Not only can we catch abnormal female problems, but also abnormal moles, skin cancers, and other issues. Most women don't know, and often can't see, if something is normal or not.

The bottom line? There is really no time when a woman should stop seeing her gynecologist for pelvic exams. Annual pelvic exams can save lives. It's Pap smears that a woman might discontinue based on her specific circumstances. Talk to your doctor for more information.

If you've heard about the recent controversy on pelvic exams in the news and would like more information, read our original post from Dr. Seacat: In the News -- The Pelvic Exam Controversy.

Courtney A. Seacat, M.D., is an OB/GYN physician. She practices at INTEGRIS Women’s Health Edmond. Dr. Seacat received her medical degree from the University of Kansas School of Medicine in Kansas City and completed her residency at the University of Oklahoma. Her special interests include prenatal care, birth plans, preventive health care, general gynecology, teen health and contraception counseling. She can be reached at 405-657-3825.