Rethinking the gynecologic examination.(Curbside Consultation)

Publication: American Family Physician

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COPYRIGHT 2003 American Academy of Family Physicians

Case Scenario

Current guidelines recommend initial Papanicolaou (Pap) tests three years after females become sexually active or at age 21 in sexually inactive women. (1) My patients seem comfortable when I tell them they don't need annual Pap smears. Yet, in teaching settings and among colleagues, I often hear the question, "If we're not doing Paps, shouldn't we be doing something?" Sexually transmitted infection screening, contraceptive counseling, safe-sex advice, and clinical breast examination are opportunities that are missed if patients don't come to the office for annual Pap tests.

Many women of reproductive age seek health care if they need contraception (but do they really need physician visits for that?) or if they become pregnant. What should I tell my patients about Pap tests--see you in three years? Come back when you need help? Or, I want to see you annually, just not for a Pap test?

Commentary

These questions often arise but without any obvious answer because the practice of medicine is an art as well as a science. The history of the annual physical examination for healthy women illuminates the "science" of medicine. The American Medical Association (AMA) first proposed an annual physical examination of healthy persons with a standard battery of tests in 1922. (2) Over the years, the public embraced the proposal with 58 to 71 percent approval. (3) But, in 1983, the AMA withdrew its support for the standard annual physical examination in favor of specific, clinically proven preventive services. (4) Blood pressure screening and Pap tests for women are screening practices with proven effectiveness that save lives and reduce...

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