How Often Do You Really Need Gynecological Check-ups?

Lying on an exam table with our feet in stirrups and a speculum inside our vagina isn't exactly most women's favorite activity. Most women, I'm willing to bet, dislike having pelvic exams just as much as they do going to the dentist — even though pelvic exams done right do not typically hurt. Despite this near-universal dislike, many women, American women in particular, subject themselves to annual pelvic exams because they believe them to be an important part of preventative healthcare.

Are those yearly trips to the OBGYN really necessary, though?

What Usually Happens At A Routine Gynecological Appointment?

If you haven't been for a routine gynecological check-up before, you may wonder what actually happens during these appointments. Gynecological well-woman check-ups in the US traditionally, and often still do, involve the following aspects:

• Recording basic information such as blood pressure, heart rate, and weight.
• A chat about your personal and family medical history, if you are seeing a provider for the first time.
• A chat about your reproductive life, menstrual cycle, and any strange symptoms you may have noticed.
• An external genital exam followed by an internal exam performed with a speculum, during which the provider will take a look at your cervix. A bimanual exam may be performed, during which the provider uses their fingers and hands to get a general impression of the state of your uterus, fallopian tubes, and ovaries.
• You may receive a PAP smear, which checks for abnormal cervical cells.
• STD testing, where relevant.
• A breast exam.

Who Can Perform A Gynecological Exam?

Besides obstetricians/gynecologists, family practice doctors, nurses, physician's assistants, and midwives may all perform pelvic exams of the type described above. In fact, nearly every healthcare provider will know how to perform a gynecological check-up, but that does not necessarily mean they provide that service. In the Netherlands, where I live, my family doctor's assistant usually does PAP smears, for instance, while my friend in England gets hers done by her general practitioner.

READ OBGYN Virgins: What Teens Should Expect From Their First Gynecologist Appointment

Are These Exams Unpleasant?

If you're going for your first gynecological exam, you are bound to be a little nervous. The good news is that internal pelvic exams do not hurt, and PAP smears should not produce anything beyond the mild discomfort you may experience when you have menstrual cramps. Routine gynecological check-ups do not typically take any longer than 15 minutes and are no big deal.

You do, of course, have to get yourself to a doctor for one, something that will likely cost you money as well as time, depending on where you live and what your insurance policy is like. Even experienced patients who know that pelvic exams don't hurt may still find the exams highly unpleasant as well, because they do involve taking your clothes off and having a medical professional interact with your most intimate parts.

Do You Need That Annual Gynecological Exam?

The annual pelvic exam was a rite of passage all women living in the US — though not many other parts of the world — were encouraged to go through until very recently. By getting routine check-ups, it was thought, doctors would be able to catch problems ranging from cervical cancer to ovarian cysts (long) before women would begin suffering symptoms, thus opening the door for timely treatment.

However, the American College of Physicians introduced new guidelines in 2014 suggesting that healthy, low-risk women don't actually need annual routine pelvic exams at all. After looking at the currently existing body of scientific data, the panel that devised the new guidelines concluded that there is no valid medical reason for these routine check-ups. Indeed, the panel noted that pelvic exams often cause a significant amount of distress in individual patients, as well as that they can lead to surgery that wasn't really needed.

You Still Need PAP Smears (But Not Every Year)

There's a big "but" here, though: the American College of Physicians still fully recommends that women undergo PAP smears at regular intervals, as do physicians across Europe and the rest of the world. PAP smears screen for changes that can indicate cervical cancer, and can be life-saving.

Women should have their first PAP smear at age 21, and then repeat the procedure once every three years until they turn 29. Women aged over 30 may consider, in conjunction with their healthcare provider, having a PAP smear every five years as long as it is combined with a test for HPV. PAP smears are no longer generally necessary in women over 65.

These guidelines, it should be noted, apply only to women whose results have been normal. Those with risk factors such as HPV, previously identified precancerous cells, a weakened immune system or prenatal exposure to DES should have more frequent PAP smears.

READ 7 Signs That Your OBGYN Sucks

Is That It, Then?

Can you stop having annual pelvic exams, then? The American College of Obstetricians and Gynecologists still recommends them, unlike the American College of Physicians. Not all medical professionals agree, then.

Meanwhile, if you do decide to stick to PAP smears at the recommended frequency while skipping annual pelvic exams, don't forget that your health depends on your active participation as a patient a great deal. If you do notice pelvic pain, unexplained menstrual bleeding, or suspect you could have a sexually transmitted disease, it is your responsibility to make an appointment right away. You will also still need to see your OBGYN or another qualified healthcare provider for your birth control needs and during pregnancy.