If you’re dreading your next pelvic exam, check with your doctor. You might not need to have one every year.

Dr. Jennifer Mitch

When Dr. Jennifer Mitch of Novant Health Bradford Clinic OB/GYN - Ballantyne began training in obstetrics and gynecology in 2010, women expected to get a yearly pelvic exam, even if they were healthy. That’s because the accompanying Pap test (also known as a Pap smear) could reveal the presence of cervical cancer, or precancerous cells.

The development of a vaccine to prevent infection with the human papiloma virus (HPV), which causes more than 99% of cervical cancer cases, and advanced testing for high-risk HPV viruses has led to a change in the thinking of how often otherwise healthy women would need to get a regular Pap test.

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In 2006, the Food and Drug Administration approved Gardasil, an HPV vaccine for girls/women 9 to 27 that could prevent strains of HPV infection.

There’s a strong link between the adoption of the HPV vaccine and change in frequency that women are getting yearly pelvic exams.

By the time Mitch joined Novant Health in 2018, The FDA raised the age of eligibility for the vaccine to 45, giving access to the vaccine to a new generation of women.

At her clinic in Charlotte, she provides both obstetrical and pregnancy care as well as office-based gynecologic care and surgical procedures for treatment of gynecologic problems.

She and other doctors, along with the American College of Obstetricians and Gynecologists, now recommend that women under 30 get a Pap test every three years. After 30, the guidelines have relaxed to exams between three and five years.

Women over 30 also could wait up to three to five years for their next pelvic exam if they do not have an abnormal Pap test. And more are not, thanks to the HPV vaccine.

But some women still want to get a regular Pap test, and Mitch feels that yearly Pap testing should still be an option for patients. “If patients are not comfortable waiting three to five years, then it's OK to do a Pap test more often,” she said. And most insurance continues to cover them.

The fear of contracting cervical cancer is still daunting for many women, Mitch said. HPV is the most common sexually transmitted disease. It's so common, in fact, that almost every sexually active person will contract it at some time in their life if they do not get vaccinated, the CDC reports.

Caught at an early state, cervical cancer has a five-year survival rate of 91%, but that rate goes lower if the cancer has spread to nearby tissues or lymph nodes, according to the National Cancer Institute.

Why you should get a pelvic exam

A pelvic exam is recommended for women hoping to get pregnant or those with chronic conditions such as endometriosis or abnormal bleeding or pain. In a pelvic exam, a doctor will check the skin outside the vulva for any sign of cancer. Mitch notes that types of skin cancers that dermatologists often find on your body can be present inside or outside the vulva.

Then the pelvis is examined internally and externally, using a gloved hand, for any masses around the uterus or ovaries.

A Pap test can be part of a pelvic exam, but a Pap test and a pelvic exam are not the same thing and one can be performed exclusive of the other.

A Pap test obtains cells from the cervix to determine if there are any abnormal cells. And what about advances in one of the most daunting pieces of equipment used in Pap tests, the speculum?

“Nothing new and exciting there,” Mitch said.

Testing on the detection of HPV is advancing so quickly that screenings for cervical cancer might eventually first be done with primary HPV testing, a procedure that now is being done elsewhere but not the United States.

That might eliminate the need for a regular pelvic exam for even more women, Mitch said.

“That hasn't been adopted here in the United States yet. As testing for HPV continues to advance, primary HPV screening may lead to better identification of those women at risk for cervical cancer. We may not do Pap testing anymore, and we may do testing for HPV first,” she said.

Ultimately, you and your OB-GYN or other health care professional should make the decision together about how often you need a pelvic exam. Openly discussing your health history, along with your concerns, can help determine the frequency that is best for you.