Clinician perspectives on the annual gynecologic examination: Is it time for a change?

Background: Recommendations for cervical cancer screening intervals have been extended to every three years, starting no earlier than age 21. The necessity of annual bimanual pelvic examinations is unclear. We sought to understand how clinicians view the prospect of longer intervals between routine gynecologic examinations.

Study Design & Population: A nationally-representative mailed survey of gynecologists (n = 521, response rate 62%) was conducted in 2010-11. Clinicians were asked about their views on the importance of annual gynecologic examinations and their beliefs regarding the consequences of extending the interval to every 3 years for women across the lifespan.

Results: According to the clinicians surveyed, annual gynecologic examinations by definition include a bimanual pelvic examination. The majority of gynecologists (69%) considered an annual examination very important for women in their reproductive years. For women in menopause, fewer considered it very important (55%). Patient satisfaction, contraceptive provision, and patient health were viewed as likely to decrease with longer intervals between gynecologic examinations, along with clinic volume and financial reimbursement. Respondents were evenly divided regarding the effects of longer intervals on their job satisfaction.

Conclusions: Gynecologists believe longer intervals between routine gynecologic examinations would have negative repercussions for patients and their medical practices. Further research is needed to assess the clinical importance of pelvic examinations, as well as patient preferences for routine gynecologic care. Redefining annual gynecologic examinations as opportunities for contraceptive counseling and other health maintenance activities could address some of the potential negative consequences of less frequent pelvic examinations identified by clinicians.