The cornerstone of good patient-doctor relationships is rooted in communication. In the initial discussions, concerns are voiced and plans take form. The astute physician draws from the mental playbook creating a differential diagnosis. Focused physical exams verify or excluded presumed diagnosis.
So, if a woman is without complaint gynecologic complaint, is the pelvic exam necessary? Yes, the bimanual exam once a teeth-grinding rite of passage never-wanted may be a thing of lore.
The American College of Gynecology (ACOG), the governing body for practicing gynecologists and obstetricians has issued updated guidelines for annual “Well Women” exams. In this assessment, they have made clear recommendations when to perform pelvic exams in asymptomatic women and when to begin clinical breast exams.
ACOG clearly promotes and recommends schedules exams for vaccinations and screening such as Pap smears and bone mineral density testing in selected populations. They recommend pelvic exams be performed when indicated by medical history in women after the age of 21. A pelvic exam may seen “logical” for those women over the age 21, however, no evidence exists to either support or refute their utility for detecting disease in low risk patients. The exam is appropriate at any age for patients presenting with symptoms.
This document also promotes breast self-awareness which includes periodic breast self exams. Changes in breast exams should be reported to her physician. ACOG, the American Cancer Society and National Comprehensive Network recommend clinical breast exams every one to three years in women under the age of 39 and every year thereafter.
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