More than a PAP SMEAR: Why women over 50 still need an Annual Gynecologic Exam
Have you been skipping your annual visit with your gynecologist? Or getting a pap smear at your primary care physician's office? If so, you may be missing out on a critically important yearly visit with the specialist who best understands women's health issues. We asked WomanCare at NCH's Obstetrician and Gynecologist Randall Kahan, M.D. why it's still important for women over 50 to schedule an annual gynecologic exam, and how WomanCare at NCH can help.
What does a gynecologist do for the woman over 50 at an annual exam?
We look at changes in vaginal discharge, ovarian cysts, changes in uterine size and presence of cervical polyps that may be signs of early disease. The patient may have evidence of pelvic organ prolapse. This will lead to questions about urinary symptoms such as incontinence, hesitancy and urgency. More often than not, if I don't ask questions about subjects that patients may be too embarrassed to talk about, they won't tell me. And if no one examines the vagina, they're not going to be able to detect these things.
What are the standard "checks" for the woman over 50?
Height, weight, body mass index, evidence of osteoporosis, clinical breast exam, and a colorectal screening exam if they haven't had a recent colonoscopy. We ensure they have received the proper immunizations. If a woman hasn't seen a primary care physician, we assume more of that role and we test for diabetes, thyroid and cholesterol. We spend some time talking about diet and exercise. We take an in-depth medical history so we can offer genetic testing to those who may be candidates. We perform a pelvic exam using a speculum to visualize the vagina and cervix and we do a bimanual exam to ensure the uterus and ovaries have no detectable abnormalities. The inspection leads to a lot of other questions. For example, I might see on examination that a patient's bladder has dropped. There are many problems with the bladder and it's our job to figure out what is wrong. (See Dr. Kahan's presentation, Bladder, Bladder What's the Matter?)
How do you try to help the woman over 50?
The female anatomy is very complicated and I believe part of a good examination is educating a woman on her anatomy and the changes that are taking place. I have a lot of visual aids on my computer to help them understand why they are experiencing some of the symptoms that oftentimes occur in this age group. I also talk about calcium and vitamin D supplementation, and the importance of weight-bearing exercises. It's not just good for weight loss and cardio health, it's essential for bone health. We ask about symptoms that may be related to menopause. I think there are a lot of things that need to be discussed in a 25-minute visit that are probably not covered by other physicians.
Do you have advice for women who experience pain during intercourse? Pain with intercourse is definitely a very common symptom of menopause and is completely treatable. There are very safe hormonal remedies and now we offer laser vaginal rejuvenation which is a painless office procedure that restores the vagina to the premenopausal state. Most women are candidates for these things.
In what ways is an annual exam beneficial for the symptomatic menopausal woman?
There are many modalities that we can use — both herbal and medicinal — that are satisfactorily treating the symptoms of menopause. There are also antidepressants that are marketed under different names. In lower doses, they can treat menopausal symptoms. In addition to treating the mood swings and anxiety that may arise, they also treat hot flashes. After talking to my patients, we agree on a therapy regimen and I have them come back in six weeks to discuss it, oftentimes with a symptoms diary. There are so many different things that can lead to the resolution of these symptoms. I really don't like the idea of a woman out there suffering from menopausal symptoms unnecessarily.
What about the fear of breast cancer?
An important component of the annual exam is a thorough breast exam. Oftentimes, patients have benign symptoms such as breast pain that leads to fairly significant anxiety. In addition to educating the patient about the changes that are taking place in their breasts, there are many herbal remedies that adequately treat benign breast pain. This is not something that is discussed during a typical internal medicine examination.
Does a woman who has gone through hysterectomy still need to visit annually?
The gynecologic exam is not just about the uterus and the vagina. It's about life problems that develop when there's no estrogen around. That woman is more likely to have problems with pelvic organ prolapse. She may have pain with intercourse. Those things will be addressed and treated. If there's a hysterectomy where a patient still has her ovaries, she will require an examination. There are things we need to talk about — constipation issues, bladder, breast examination, discussion about weight loss, osteoporosis, to name a few. I think the pap smear never was the sole reason for why a woman should go to a gynecologist.
Why do you think women tend to stop visiting the gynecologist after 50?
Due to the recommendation by some of the medical governing bodies out there that say women need a pap smear once every three years, patients interpret that to mean that they only need to visit their gynecologist every three years. This is a misconception that is not supported by any of these governing bodies. All insurance companies continue to cover the annual gynecologic exam which includes the pap smear, up until age 65.
Why is this dangerous?
Patients are missing out on all of the other things that a gynecologist does during the annual exam. And if they're just seeing a primary care physician, they only have 15 minutes to cover things like cholesterol, high blood pressure, medications. That doesn't leave enough time to discuss issues that are pertinent to women's health, especially those over 50 years of age.
WomanCare at NCH offers three locations and 14 highly-trained medical physicians who provide exceptional care and a wide range of services. Call today for an appointment.