Among the many indignities women face, the annual pelvic exam must be among the worst. Doctors have tried to humanize the experience with cute crocheted stirrup-warmers. Still, whenever I lie down on the table, I can't help thinking of Jeremy Irons and his diabolical instruments of torture in Dead Ringers.
So here's the good news. You can skip it. This week, the American College of Physicians, a leading medical group, said that for women with no symptoms, the routine pelvic exam is useless.
How much other stuff we've been told to do is useless? Quite a lot. Breast self-examination was discredited years ago. Pap smears, which used to be an annual event, have been downgraded to every three to five years (or never, if you're old enough). Mammograms don't work for women under a certain age (experts disagree what age that is), and most of us don't need them very often after that. Comprehensive physicals every year? Meh.
Pelvic exams are not effective as a screening tool for ovarian cancer. They're not necessary for detecting sexually transmitted diseases or for prescribing contraception. In Britain and other countries, they aren't done at all for women with no symptoms.
The trouble is that so-called preventive medicine sometimes does more harm than good. As a wise old doctor told me once, "The definition of a healthy person is someone who hasn't been tested enough." The more tests you get, the more likely they are to find something suspicious – a lump, a shadow – that turns out to be nothing. And sometimes, as with pelvic exams, the chance that it's nothing is far, far greater than the chance that it's something.
Gynecologist George Sawaya, a professor of obstetrics at the University of California, told The New York Times that he's done plenty of surgeries because he found an enlargement during a routine pelvic exam. "Nearly always it's benign," he said. He has called routine pelvic exams "more of a ritual than an evidence-based practice." Other experts believe that the frequency of pelvic exams helps explain why American women have twice the rate of hysterectomies that European women do.
But we do love our rituals. Despite the lack of evidence that pelvic exams make any difference, gynecologists still swear by them. This week, both the American College of Obstetricians and Gynecologists and its Canadian equivalent stuck by their guns. There are other benefits, they say. For example, some younger women think they "look weird," and are reassured to learn they're normal.
I guess it's nice to know one's private parts are no weirder-looking than anybody else's. But the cult of wellness and prevention has gone too far. My suspicion is that some doctors use the ritual of an annual exam just to get you in the door. With fewer and fewer serious illnesses to treat, your friendly family doctor has basically become a test-orderer, a prescription writer and a dispenser of banal lifestyle advice that you will probably ignore. Don't smoke! Get more exercise! Lose weight! They also medicalize the trivial. Show up with a sore finger and they're likely to order up an MRI. In the olden days, the doctor would have looked at you and said, "That, my dear, is age."
Yet the cult of wellness has a grip on us all. My women friends are religiously proactive about their health. They never miss a mammogram. They compare their bone-density results. They think that just because there's nothing wrong with you is no reason not to see the doctor.
But now there's one less reason, and I, for one, am grateful. With luck, I'll never have to think about Jeremy Irons again.