Dear Dr Murage,
I had an argument with a friend about whether a gynaecological exam is recommended as an annual exam or just a routine exam. What’s the difference anyway?
The words 'routine' and 'annual' are self-explanatory. The combination of the two words in matters of women's health almost implies a repetitive ritual which may turn out to be more mechanical than objective. The gynaecological world is full of proponents for an annual gynaecological exam, and opponents for the same in equal measure. You will therefore likely get confused if one specialist recommends an annual exam, whilst their colleagues just rubbish the practice.
So why an annual gynecological exam? It is an opportunity to review your reproductive health, regardless of any ongoing symptoms. You start off with some sort of a check-list consult, then end up on the couch for a physical exam of your reproductive system.
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You get your screening tests done at the same time. Unsurprisingly, nothing abnormal ever gets found for the majority. You then get reassured that all is well, pay your bill, and get another appointment arranged for the same ritual a year down the line. Time and money well spent?
What about the opposite view? Every visit to your gynaecologist must have a specific goal, based on your individual characteristics and prevailing health status. Most conditions will present with some symptoms, and these should be checked whenever they arise. True, some conditions will creep up silently, and that's why you get recommendations for regular screening for such conditions. More frequent screening than scientifically justifiable is hardly beneficial. Subjecting yourself to an uncomfortable gynecological exam when nothing is the matter is questionable.
Is there a balanced view? Scientific studies have tried to look at the routine annual gynaecological exam from various angles. The overall benefit to women is difficult to prove.
There can even be inadvertent risks, like when a benign condition gets diagnosed and unwarranted interventions get proposed. True something unexpected may come up, but this is a rare occurrence which must be put into perspective. The economic downside is massive, both in time and monetary terms, raising doubts on cost-effectiveness. Some specialist authorities have gone to the extent of advising against this annual ritual.
Your gynecologist may have their views about an annual exam. But you alone gets to decide what gets done to you. Question the value of any recommendations. If the overall health benefits are wanting, don't keep subjecting yourself to a habitual practice.
— Dr Alfred Murage is a consultant obstetrician and gynaecologist