WAIT, NO PELVIC EXAM?

Why this resource is helpful:

"When I was in residency (before computers or Snapchat or memes! Yes, I am old!), we were encouraged to do A LOT of pelvic exams. I always felt sorry for the unfortunate woman who would show up at a teaching hospital with pelvic pain. She would first get a pelvic exam by a medical student, then an intern, then a chief resident and if something seemed really wrong, an attending physician. If she didn't have pelvic pain when she walked in, she sure would when she left. I am cringing as I write this.

We also did pelvic exams if a woman needed a refill of her birth control, or a routine STD check. Why??? There are important reasons that this is no longer necessary. Every woman should know these reasons.

* Pelvic exams were routine because it was all we had . . . 20 years ago. Western medicine is a like a large ship that is only able to turn very, very slowly. And a 180 degree turn takes decades. Pelvic ultrasounds are widely available and much more accurate, with some exceptions, than a hands-on pelvic exam 'bimanual' in doctor speak). If a woman has pelvic pain or abnormal bleeding, I usually will do a pelvic exam but I will also order an ultrasound. If she is someone who is morbidly obese or finds pelvic exams traumatic, I will sometimes skip the exam and go right to the ultrasound.

*The American College of OB-GYN (ACOG) has finally come around to recognizing this. Their guidelines specifically state: 'pelvic' examinations should be performed when indicated by medical history or symptoms. (Committee Opinion #754, October 2018, if you don't believe me.)

*We can now do most STD screening with a simple urine test. If a woman needs routine screening because of a new partner or peace of mind, she does not need a pelvic exam. Now if she is having unusual discharge or itching or pelvic pain, then she probably does need a pelvic.

*Pap smears and pelvic exams are NOT the same thing. Again, paps and pelvics are not the same. I want to type this twenty times, but I think you get my point. A pap smear is just a small part of the pelvic exam that screens for cervical cancer. This is now done every 3-5 years beginning at age 21, assuming the pap is normal."

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