Why no routine annual conference gynaecological checks in UK?

[stoppedlurking56]

Am I missing something?
When I lived in Germany/Belgium all of my female colleagues would have annual appointments with a gynaecologist - like we do here with the dentist. This was years ago when we were all mid to late-twenties, and I forgot about it til after I came back here and had a pregnancy and hospital birth... I've always wondered if women's gynaecological health is worse here in the UK because of it.
How could I see a gynaecologist here for a full checkup - would I have to go private? I'm British and living in Scotland now, late thirties. I've never had such a routine annual check either abroad or here. I'd like to understand the differences in the systems.
I posted in FWR because it strikes me that women's health is pretty far down the NHS list of priorities - but interested in others' views. Am I right to notice this?

[stoppedlurking56]

Sorry, first post and I don't know how 'conference' crept into that title....pls ignore!

[Shallishanti]

do you have any concerns about your health?
I can see the point of regular dental checks, but not sure what a gynae check up would be for, exactly....smears aside of course. Sounds to me like a money spinner for the Drs.

[NitramAtTheKrap]

I don't have a medical background, but doubt gyne health is worse here because of it.

I would feel really uncomfortable about this, instinctively it feels like some sort of control/observation of women type thing.

[exexpat]

You can get well-woman checks at private clinics, e.g. through Bupa - I did one once when I had been living overseas for several years and was overdue for a smear check.

I would guess that the reason the NHS doesn't offer annual checks like this is because they may not necessarily improve the overall health of women, or at least not in a cost-effective way. I think differences in the way doctors are paid may explain why gynaecologists in some countries, particularly the US, encourage regular check-ups and screenings when other countries do not feel the need.

I am not involved in healthcare, but I have read a lot of evidence about how unnecessary screenings/scans can lead to vast numbers of false positives - people being referred for further tests or even treatment for things they turn out not to have, or which they do have but which would never have caused a problem (e.g. very early stage prostate cancer, some very slow-growing breast cancers). Margaret McCartney has written some interesting stuff about this.

[Shallishanti]

.....or the idea that men=normal, women=abnormal, and therefore prone to all sorts of disease. Do men in Germany/Belgium have andrological check ups annualy?

[CMOTDibbler]

You have to ask yourself what good an annual check would do tbh. The Uk has a national cervical screening programme, and the optimum frequency for the population has been calculated to be 3 yearly, and women are chased to attend these.

Men aren't routinely called for health checks either, but GP practices often offer 'MOTs' to specific age groups for the major health issues like weight, blood pressure, cholesterol etc

[Bellossom]

What's the need? What kind of things do they find out?

I would decline anyone examining me anywhere without good reason.

[stoppedlurking56]

A friend in Germany had small tumours in her womb detected and they could be removed before they became bigger - cancerous. No other symptoms. I get my smears of course as per NHS. I have no agenda, I am just curious. As a layperson I don't know whether these checks are truly necessary or not. But obviously if I had cancer tumours as per my friend then yes, I'd like to know sooner rather than later.

[doradoo]

I live in Germany and it's an annual 'well-woman' check here - smear / breast exam / sometimes depending on insurance or if you want to pay extra a TV ultrasound to check ovaries - and general urine/bp/weight etc.

Presumably so that if there are any probs they are picked up at an earlier stage and are therefore easier to treat?

When you hear stories of young women dying because they can't access appropriate screening it makes you thankful for what you get 'as normal'

I don't consider it in any way 'a control/observation' issue - it's part of the very proactive and preventative approach to healthcare here rather than reactive which is what it seems like in the UK.

[exexpat]

Health screening can do more harm than good. I'm sure there are arguments on both sides.

[CaptChaos]

I can see the point of an annual check up, not necessarily a gendered one though. You can attend a well woman clinic here, if your GP offers one.

[stoppedlurking56]

I'm genuinely surprised that the majority so far wouldn't welcome these. Fair enough. I feel the opposite - that I'm missing out on something which other developed countries see as important. I suppose the only way to know would be to look at statistics, but that's very difficult for us here on this thread. Disclaimer: I have had issues with bad gynaecological advice from a GP so I suppose I am slightly mistrustful in that respect.

[dreamingbohemian]

I agree OP, annual exams are common in the US as well

They are NOT just smears, those are done maybe yearly if you are high risk but otherwise every 3-5 years

The doctor also does a breast exam and checks your ovaries, which I think is a good thing. It's a chance to review contraception, get a new prescription if necessary. Other general physical checks like blood pressure (important for some contraception). Also a chance to share any concerns that might not feel enough for a proper doctor's visit... lots of women get referred into mental health services by their gynos, for depression or anxiety.

It's also good as you get older to see a doctor specialising in women's health, as many conventional treatments and drugs are developed using male subjects and may have different effects.

So it may not seem cost-effective but actually it's a good way to squeeze lots of stuff into one short visit. Early detection is key for so many things and I do think this is a feminist issue.

[Knottyknitter]

Over investigation is not generally a good use of resources.

Most gynae screening in the uk is done in primary care, not by gynae themselves, and most dentistry is paid for.

I see a lot of patients who have had excessive screening tests done overseas and return demanding nhs gynae referral. None have needed it (once the records have been located and translated)

[Earlybird]

I think some countries advocate regular preventative health checks (helps especially with early detection).

Other countries advocate dealing with a problem when it arises (though sometimes things have advanced significantly by the time you are aware there is an issue that requires a visit to the doctor).

In America, women are advised to have a smear every year - especially once they are sexually active and if they are / have been intimate with more than one partner in that year.

Some may say once a year is too much. However, I was very grateful when some precancerous cells were discovered at my annual exam/smear. In the year since my previous smear, the cells had progressed quite rapidly to the most serious stage. If they had not been detected so early, I would have had a much more serious health issue.

[Blistory]

It's insurance driven in many other countries and I suspect that the reason is not because any illness is easier to treat if discovered early but that it's cheaper to treat if discovered early.

Despite looking, I cannot find any research that shows the benefit of young women going through puberty being given breast and internal pelvic exams as seems to be relatively common in the USA.

[stoppedlurking56]

Interesting, pp living in Germany. I may arrange a check next time we're over. I think the difficulty I have is that many issues are latent, so how would I know that I should go to the doctor.

[stoppedlurking56]

Thanks everyone, signing off now.

[SevenZarkSeven]

Agree with the points about over-screening / testing being as iffy as under-testing.

A whole cohort of young women got chunks cut out of their cervixes, for e.g., before they realised that in late teenagers the "problems" that they were seeing were actually quite normal. I know as I was one of them. Even more bizarrely, when I told this to GP, midwife, etc when I had the kids, they didn't believe me! WTF!

Anyway that aside

Also agree with others about the whole poking women around the whole time on the basis their bodies are liable to malfunction a bit off, and a hangover from the time when our weird womanly parts were meant to be the direct cause of all sorts of ailments eg hysteria.

The allocation of NHS resources is extremely difficult and I would rather funds were spent on things that are statistically likely to make the biggest difference rather than on annual checkups for women which will likely have extremely minimal overall impact and may in some cases be counter-productive.

[SevenZarkSeven]

You've got to remember OP that people will think of the prevailing way things are done in the country they were born and raised as the "norm" and if nothing has gone too far wrong they won't see much wrong with it.

Also people in the UK are highly protective / defensive about the NHS.

Incidentally I get "women's health" screenings through work. The quality of them is extremely variable and I'm not sure of the value of them at all beyond, it makes you feel good to have a chat with someone and get a printout later saying you're fine. It's nice to have the reassurance but expensive for the NHS for little return on what they get at the moment. Also one year I got referred for something which the consultant said was nothing and should never have been referred so I had to get all stressed out and wait and worry etc. It was the scar from the procedure I had on my cervix when young which I mentioned in previous post. So that was shite, frankly.

[dreamingbohemian]

Just to add, nobody forces you to have an annual exam in the US, it's just that most insurance companies will pay for one each year. Usually if you have some issues you might go every year but probably most women go every few years (they no longer recommend annual smears for most women).

I know there are dangers in over-screening but early detection is so important for things like ovarian cancer. My understanding is that doctors think the exam itself is pretty important, even if not always necessary every year. I think only going to the GP when you have symptoms can be pretty dangerous for a lot of female cancers.

[SevenZarkSeven]

What is the test for ovarian cancer that they do at the screening?

My work one they did smear, breast check, bloods, well done for losing weight, woah shit stop drinking so much. blood pressure. um.that was it I think

[SevenZarkSeven]

the men get one too as well though

do the men in the US get one a year with their insurance as well?

[doradoo]

seven in germany the gynae does a tv ultrasound to check ovaries.

stopped if you wanted a check when you're in DE - assuming you have the right insurance you could go to any frauenartz you like for your check.

My state insurance pays for an annual well-woman check - it's my only contact with the medical profession as I don't have a gp so I'd flag any issues up with her and then ask who she suggested I see. Here you see a specialist rather than a gp (e.g you have a skin prob you see a skin doc, an eye prob - and opthalmologist and so on). GPs do exist but you dont necessarily have to see one first - or even be referred by one.

The gynae is a specialist - usually covering obstetrics too and has IME a fully kitted out surgery with ultrasound machines etc on site to do most routine checks. Both the gynae docs I have seen here have been women.