GYNECOLOGY 101: Pap Smear, Pelvic Exam and the Well Woman Exam – Is There A Difference?
by Ngozi Osuagwu, MD | August 7th, 2016
I recently asked my daughter what classes she would be taking this coming semester in college. She told me she would be taking a math class, a science class and an elective. I asked her would she consider an elective like Gynecology 101. She laughed and said they did not offer that in her school. I looked through the catalog and she was correct, there was no Gynecology 101. Would it not be great to have a course that addressed some of the common questions in gynecology – Is a pelvic exam the same as a pap smear? Do you always need a pap smear during your well woman exam? When do you start getting pap smears? Does a hysterectomy make you go into menopause or does having uterine fibroids mean that you definitely need a hysterectomy?
I have decided to offer my version of Gynecology 101. The main objective is to answer some of the common gyn questions. No registration required, just continue to read the weekly blogs. Sorry, no college credits offered , but your knowledge will be increased. For the next five weeks, five of the most common questions will be addressed.
Gynecology 101- Pap smear, pelvic exam and the Well Woman Exam – Is there a difference?
A pap smear is a screening test for cervical cancer. If the pap smear is abnormal, it tells us that you need additional testing so that a diagnosis can be made. We start to perform pap smears at age 21 years. We do not perform pap smears yearly unless you have had an abnormal pap smear and you require close monitoring. For the person who is 21 – 30 years old, we generally perform a pap smear every 3 years if the pap smear is normal. If you are over 30 years old and you have had a human papillomavirus (HPV) testing along with your pap smear and both are normal, you will probably get your pap smear every five years unless you have a history of having an abnormal pap smear, history of positive HPV or you have been treated for precancer of the cervix. Some have said that the change in frequency of getting pap smears is a conspiracy against women and that the insurance company is dictating how often pap smears are performed to save money. This is not correct. Getting a pap smear every year will not prevent you from getting precancer of the cervix. The purpose of a pap smear is to catch abnormalities before it becomes cancer so that you can be treated. To decrease your risk of getting precancer or cancer of the cervix, you should not smoke, you should not have multiple sexual partners, you should use condoms and you should get the HPV vaccine. A pap smear is one of many tests that can be performed during a pelvic exam.
A pelvic exam consists of three parts. The first is the doctor looking and inspecting your external genitalia or the vulva. Please check out the blog titled, What Is Really ‘Down There’? The second part of the pelvic exam consists of putting a speculum in the vagina to look at the vaginal wall and check the cervix. The third part is putting two fingers in the vagina and pressing on the lower abdomen with the other hand. This is called a bimanual exam. The pelvic exam allows for the gynecologist to evaluate for any abnormalities like an ulcer, vaginal discharge and size of the uterus among other things. During the pelvic exam, a pap smear can be performed as well as testing for sexually transmitted infections (STIs). A pelvic exam can be done without performing a pap smear, however you do need to put in a speculum to perform a pap smear. It is so important after the exam to find out what tests were performed by your doctor.
A well woman exam or annual gyn exam is performed to make sure that you are maintaining good health. It starts out with getting a history to know how you are doing and to make sure you have no problems or concerns. If you have concerns, they will be documented but might not necessarily be addressed at the current visit. Your medications are reviewed. Vital signs are obtained including your height and weight. Depending on your age, you may or may not have a pelvic exam. If you are under 21 years old, you probably will not have a pelvic exam unless you are complaining of pelvic problems. You can still get a prescription for birth control or be checked for STIs without a pelvic exam. It is during this time that your doctor will make sure you are up to date with your vaccines and up to date with screening test based on your age – for example, if you are 40 years old, you will need your mammogram.
Take home message: Even if you are not getting your pap smears every year, you still should come in yearly for your well woman exam. Under the Affordable Care Act, this exam is free without any cost sharing.
EXCELLENT Blog today Dr. Osuagwu!!!!!! My GYN 101 in college was via the book “Our Bodies Ourselves”. Class instruction with discussion and questions addressed is always better than just reading a book. I do have a question: if Pap smears are to detect abnormalities, wouldn’t it be good to have one each year vs. every three-five years, in the event that an abnormality happens a year after a Pap smear, but then wouldn’t be detected for another two to three years? Thank you so very much!
Thank you for your comments and your question. The reason that we do not need to get a pap smear every year is that it takes time to go from a precancerous lesion to cervical cancer and most times a precancerous lesion can reverse to normal. If we check every year we can end up over treating an abnormal result. These new recommendation are for women who are low risk. Most women who have been diagnosed with cervical cancer are women who have never had a pap smear or women who have delayed having a pap smear for over five years or women who had an abnormality and did not have the appropriate follow up. Thanks again for the question.
My questions, exactly, Linda K. Jackson
Thanks for the question.