A pelvic exam is a routine part of women’s health care, though many women wonder if it’s really necessary on a yearly basis. During a pelvic exam, your doctor visually examines your external genitals for any abnormalities, inserts fingers into your vagina to feel your pelvic organs, uses a device called a speculum to open the vagina and examine the cervix, and performs a bimanual internal exam by inserting fingers into the vagina and pressing on the abdomen to feel your uterus and ovaries. While this exam allows your doctor to screen for conditions like yeast infections, bacterial vaginosis, STDs, cervical cancer, and uterine fibroids, it can feel invasive for some patients. Here’s what you need to know about whether routine pelvic exams are mandatory.
Are pelvic exams required every year?
Pelvic exams used to be recommended annually for women 21 years and older as part of preventive care. However, in recent years, major health organizations have updated their guidelines to reflect that pelvic exams are not mandatory on a yearly basis for women who are not pregnant and do not have symptoms. Here’s what some leading organizations now recommend:
- The American College of Physicians recommends pelvic exams every 3-5 years for asymptomatic, low-risk women aged 21-65 years.
- The American College of Obstetricians and Gynecologists recommends pelvic exams for asymptomatic women 21 years and older only when indicated by medical history or symptoms.
- The U.S. Preventive Services Task Force concludes there is not enough evidence to recommend routine pelvic exams for the screening of ovarian cancer, bacterial vaginosis, yeast infections, trichomoniasis, or cervical cancer in low-risk, asymptomatic women.
So in summary, annual pelvic exams are no longer universally recommended. Many major health organizations now advise a less frequent pelvic exam schedule for women without symptoms or specific risk factors.
When are pelvic exams recommended?
Despite the updated guidelines, pelvic exams are still commonly performed. Here are some instances when a pelvic exam would still be advised:
- During annual well-woman visits: Some doctors continue to perform pelvic exams annually as part of a well-woman visit. This allows close inspection of the vulva, vagina, and cervix.
- Before prescribing birth control: Pelvic exams allow doctors to screen for STDs, infections, or anatomical abnormalities before prescribing contraceptives like birth control pills, IUDs, or implants.
- When experiencing symptoms: Symptoms that warrant a pelvic exam include abnormal vaginal discharge, bleeding between periods, pelvic/genital pain, or vulvar itching or irritation.
- During pregnancy: Routine pelvic exams are recommended early in pregnancy to confirm the pregnancy, check the cervix and uterus, screen for infections, and estimate gestational age.
- Before menopause: Pelvic exams can screen for uterine fibroids, ovarian cysts, pelvic organ prolapse and other conditions before menopause.
- Women with risk factors: Those with new sexual partners, multiple partners, sexual history, or family history of reproductive cancers may need more frequent screening.
Outside of pregnancy, doctors may recommend a pelvic exam schedule tailored to each woman based on individual risk factors and needs. An open conversation with your doctor can help determine what’s right for you.
What happens during a pelvic exam?
A pelvic exam consists of three main components:
- Visual external exam: The doctor visually inspects your vulva, looking for rashes, irritation, cysts, lesions, or discharge.
- Speculum exam: A speculum is inserted to open the vagina and allow visualization of the vaginal walls and cervix. Samples for Pap tests are taken at this time.
- Bimanual internal exam: The doctor inserts gloved fingers into the vagina and places the other hand on the lower abdomen to feel the shape and size of your uterus and ovaries.
The speculum exam allows your doctor to perform a Pap smear to screen for cervical cancer and precancer. Other screening tests like STD tests or vaginal cultures may be performed as well. The bimanual exam checks for uterine or ovarian abnormalities. The entire exam typically takes less than 5 minutes.
What conditions can pelvic exams detect?
When performed by a skilled provider, pelvic exams can detect or provide clues for the following conditions:
- Sexually transmitted diseases like chlamydia, gonorrhea, genital warts
- Vaginal yeast infections
- Bacterial vaginosis
- Urinary tract infections
- Cervical cancer and precancer through Pap tests
- Uterine fibroids or polyps
- Endometriosis
- Ovarian cysts
- Pelvic inflammatory disease
- Uterine, cervical, vaginal, or vulvar cancers
By checking for anatomical abnormalities, inflammation, and taking samples for screening tests, pelvic exams can diagnose or provide early warning of multiple gynecologic conditions.
What about pelvic exams for cervical cancer screening?
One of the long-standing reasons for routine annual pelvic exams was to perform Pap tests to screen for cervical cancer and precancerous cervical dysplasia. However, major organizations like the American Cancer Society now recommend the following for cervical cancer screening with Pap/HPV co-testing:
- Women ages 21-29: Pap test every 3 years
- Women ages 30-65: Pap + HPV co-testing every 5 years
- Women over 65: No screening if adequate prior testing and not high risk
For low-risk women ages 30-65, only Pap testing every 3 years or HPV testing alone every 5 years are also acceptable options. So pelvic exams solely for Pap test-based cervical cancer screening are no longer recommended annually. However, women should still receive cervical cancer screening based on the guidelines above.
What are the risks of pelvic exams?
Pelvic exams require insertion of fingers or instruments into the vagina, which can pose the following risks or complications:
- Discomfort, pain
- Vasovagal response (fainting, nausea, sweating), especially in cases of sexual trauma
- Urinary tract infection
- Introduction of bacteria into the uterus, leading to infection
- Spotting
Use of a speculum and cervical sampling during a Pap test can also cause light bleeding or spotting afterwards. While serious complications are rare, talk to your doctor if you experience fever, chills, severe pain, or heavy bleeding after a pelvic exam.
Should you decline a pelvic exam?
Some low-risk women may opt to decline pelvic exams if not medically necessary. However, it’s important to discuss the pros and cons with your doctor first. Key points to consider if declining pelvic exams:
- You may need to specifically decline the exam – it may be routine practice for your provider
- Be prepared to discuss your individual risk factors and symptoms
- Understand that some doctors require exams before prescribing birth control
- You’ll need to stay up to date on cervical cancer screening per the current guidelines
- Get any recommended STI testing through urine samples or vaginal swabs instead
- See your doctor promptly for any gynecologic symptoms that develop
Declining pelvic exams requires good communication with your doctor and awareness of potential gynecologic symptoms that still warrant prompt evaluation.
Are pelvic exams mandatory for sexual assault survivors?
Pelvic exams are never mandatory for any patient. However, they are commonly performed in sexual assault cases to collect forensic evidence, test for STIs that may have been transmitted during the assault, and look for and document any physical injuries. Key considerations for sexual assault survivors:
- Give full consent before the exam – providers will explain the purpose and process
- A forensic rape kit exam does not require penetration if you decline
- You can accept or decline any part of the exam
- You can have a support person present if desired
- Follow up care is recommended to re-test for STIs and monitor for pregnancy
While pelvic exams facilitate crucial evidence collection and medical care, they are never mandatory. Assault survivors have full rights to accept or decline any part of the post-assault exam.
Pelvic exam frequency recommendations
Here is an overview of general pelvic exam frequency recommendations from major health organizations:
| Organization | Recommendation |
|---|---|
| American College of Physicians | Every 3-5 years for low-risk women aged 21-65 |
| American College of Obstetricians and Gynecologists | Only when needed based on symptoms or medical history |
| American Cancer Society | Can be discontinued in low-risk women |
| U.S. Preventive Services Task Force | Evidence insufficient to assess benefits vs. harms of screening pelvic exams |
Conclusion
While routine annual pelvic exams were previously standard, major health organizations now agree less frequent pelvic exams are sufficient for low-risk women. Screening pelvic exams are no longer recommended for all women on a yearly basis and should be individualized based on each woman’s risk factors, symptoms, and medical history. Women should discuss their personal pelvic exam needs with their doctor. But in general, declining pelvic exams can be a reasonable option for many low-risk asymptomatic women, as long as proper cervical cancer screening and STI testing are still obtained when needed.