Talk to your doctor

While experts debate the value of annual pelvic exams, Dr. Natalie Gregory of Lowcountry OB/GYN said the recent controversy shouldn't prevent patients from making appointments for their annual well-woman's check-up.

"My take home (from the recommendations) is maybe I don't need to do a pelvic exam on every single person, every single time," Gregory said.

Women should discuss their options with their doctor, she said.

Every year for the past 40 years, Melinda Norris has endured a not-so-painful, but not-entirely-pleasant pelvic exam during her annual well woman's check-up.

"It's like going to the dentist," the 48-year-old Charleston woman said. "At least you don't have to do it twice (a year)."

Despite new recommendations from the American College of Physicians, which decided earlier this month that routine pelvic exams may not be necessary for most healthy women, Norris still has faith in the procedure that detected ovarian cancer in her mother-in-law 10 years ago.

"She lived quite a few years with the cancer," Norris said. Her mother-in-law has since succumbed to the disease. "For me, I'm not going to change. I'd rather be safe than sorry."

But the American College of Physicians said on July 1 that annual pelvic exams aren't necessary for women like Norris who aren't pregnant and don't have any risk factors. The recommendations sparked a national debate among doctors, driving a wedge between those who believe the exams remain an important part of a woman's annual well-visit and those who think the procedure is essentially a waste of time and resources.

Dr. Ranit Mishori, a family physician and associate professor at Georgetown University School of Medicine, told The Associated Press that the new recommendations will rid the medical community of "an unnecessary practice."

"Many women will be happy to hear that, and I think also, frankly, many physicians will be happy to hear it," Mishori said. "Many of us have stopped doing them for a long time."

According to the new report's authors, a review of research spanning 1946 to January 2014 shows that the procedure doesn't do a very good job identifying cervical cancer or pelvic inflammatory disease and that there are many false positive findings and "harms associated with the exam," including embarrassment, fear and anxiety.

Pelvic exams are also expensive. The report estimates they cost the U.S. health care system $2.6 billion a year.

"The recommendations are controversial because they're looking at a cost-benefit analysis," said Dr. Kate White, a physician with Lowcountry OB/GYN. "As a gynecologist, I definitely feel like I've been able to help patients with problems that we find doing the annual pelvic exam that they didn't even realize were a problem."

During a typical pelvic exam, White checks a patient's bladder, ovaries and uterus, looking for tenderness, unusual discharge or other potential problems.

"There are a lot of things you can elicit from a pelvic exam that may not be obvious to patients," she said. "Sometimes ... what they think is normal is actually not normal."

The recommendations, published in the Annals of Internal Medicine, did not address the Papanicolaou test, commonly called a pap smear, which are routinely conducted alongside pelvic exams during a woman's annual exam.

White said physicians at Lowcountry OB/GYN discuss the pelvic exam with each patient, then decide how they should proceed. Health insurance plans cover the cost of the procedure, she said.

When Norris's own daughter turned 18, she set up an appointment for her first pelvic exam.

"I said, 'This is where we're going and this is what's going to happen,' " she told her teenager. "Nobody likes it."

Reach Lauren Sausser at 937-5598.