A new article published in JAMA Internal Medicine found that a majority of pelvic examinations performed on young women* between 2011 and 2017 may have been needless. Of the 2.2 million women* ages 15-20 included in the sample, 54.4% of all pelvic examinations and a whopping 71.9% of pap smears were “potentially unnecessary.”
This confirms something that Scarleteen has long known and pushed against: much as we appreciate and value them and the work they do, we know that doctors don’t always know best just because they’re doctors. Physicians aren’t always aware of and don’t always adhere to best or most current practices with their patients.
In all the work we do here, we try to always identify paths to sexual wellness that focus on patient-centered, trauma -informed care. For us, one thing this means is that it’s critical we try and help anyone who comes to our site learn their rights with medical care. For example, you always have the right to know why doctors are examining or testing you, and to have a say in when and how that happens. Some of our older pieces don’t include the more current protocols for pelvic exams, so over the next week, know that we’ll be popping into them to drop notices about this so we can be sure our readers walk into the clinic empowered with the information that you or they need.
In the meantime, our staff wanted to reflect on two important questions with you all: when is it actually necessary to perform a pelvic exam, and how can you advocate for yourself if and when you feel your doctor may not be acting in your best interests or adhering to current medical guidelines?
When do I actually need a pelvic exam?
As with any medical procedure, whether you “need” to be examined is a decision that should be made by your doctor and you. According to the American College of Obstetricians and Gynecologists (ACOG), pelvic exams are primarily indicated for folks who are experiencing symptoms, like vaginal or vulval pain or visible sores — not people who feel fine — for people who would like an exam, and folks who are pregnant. Pap smears are also recommended every 3 years starting at age 21.
Outside of these factors, a pelvic exam is probably not necessary unless the patient “expresses a preference for the examination.” That’s right - it’s up to you! If it would feel reassuring to have the exam, or if you would like to be introduced to your own anatomy , that is your right. It’s just not, and shouldn’t be presented as, a *requirement.*
Why is this essential? Not everyone is comfortable with having a pelvic exam performed. People who have experienced sexual assault and other forms of violence or abuse , who have difficult relationships with their bodies, including people experiencing gender dysphoria , or who experience anxiety during a visit can actually be harmed by the experience of a pelvic exam. The first principle of medicine is “do no harm!” So, it is your doctor’s actual job to protect you from harm unless it is absolutely critical for your health.
In sum: a pelvic exam should be your choice, which means you should get them when you need them, or when you want them, but you do not have to get them every time you visit the OBGYN as has often been thought or suggested in the past. If a healthcare provider is recommending one for you, but you think that it isn’t necessary and you don’t want one, for any reason, then you can have a conversation about that with them.
Physical examinations are like every other occasion in which someone is touching your body -- it should only be done with your explicit consent .
I don’t need or want a pelvic exam, but my doctor insists on doing one. What do I do?
If you feel like your doctor wants to perform an unnecessary exam, it’s always good to start with a little curiosity. Ask questions like:
- Can you tell me why you think this exam is necessary?
- What do we hope to learn from this physical exam?
- Is there someone here who could give a second opinion, or can I postpone the exam until I get a second opinion somewhere else?
If you’re able, you can bring a trusted support person to any healthcare visit, whether that’s a friend, partner , or guardian. You can also express to the doctor or other clinical staff that you’d like that person to join you for your appointment if you are worried about standing up for yourself when you’re alone with your provider and that other person would help you stand up for yourself and feel supported.
As best you can, listen to and trust yourself. If you feel doubt, worry, or fear in your body, it may not be a good time for an examination, even if it is necessary. Getting a second opinion or giving yourself a minute to be alone or discuss with a friend can help you decide whether you’re comfortable with continuing the visit. Unless you’re getting emergency care, it’s usually just fine to wait on an exam until you can be sure you even need it and until you feel more comfortable with it.
We also love coming in prepared! Check out this article on getting ready for a medical visit. It helps to know why you are there, what you hope to get out of your appointment, and what a standard visit might look like.
In sum: your body, your choice!
Just so you know, if anything about a medical visit ever makes you uncomfortable, it is totally within your rights to get the hell out of there. We should always seek out the medical care we need, but trusting our bodies is not just seeking care when we hurt -- it’s finding care that feels good and safe.
Don’t be afraid to try different providers, bring advocates with you to appointments, or to be assertive in a visit. This time is for you! Your provider is supposed to be just that -- a provider of a service -- and it’s their job to help, not harm, you.
If you ever need help figuring out what kind of medical care you need for a sexual health question or concern, you can always turn to our message boards or, if you’re in the US, use our text service to ask us a question, at: (206) 866-2279! The folks at Scarleteen are here to help and we’re dedicated to doing what we can to make sexual healthcare something that’s always something positive for you.
