Why no routine annual conference gynaecological checks in UK?

Personally, I don’t see why both can’t be done. At the end of the day, women’s healthcare preventative and otherwise are important.

Or perhaps HCPs could just take women and girls seriously when they report pain or other symptoms. Perhaps, when a woman or girl reports severe pain she should be referred immediately for a gynaecologist to explore the issue, rather than be told that periods are painful and to get used to it. Rather like the immediate referral and investigation I had when I reported a breast issue. Unlike what happens to most teenage girls reporting life-disruptingly severe period pain, who do not get diagnosed with endometriosis for 10 agonising years, by which time they have suffered permanent damage. No point in my seeing a gynae every year, use that spot for a woman who needs it.

How very odd.
FWIW to others who are thinking about this, I opted out at the GP surgery several years ago. I was then not harrassed or reminded for about 5 years.

It's just recently had a reminder letter, so next time I'm at the surgery I will be opting out again. The relief of not getting the letters, not being asked every visit, not almost forced to have one there and then when I went for something else like blood pressure check is immense.
I could feel the dread come over me as soon as I got the letter a few weeks ago. I hate the feeling so much. And anyway at my age it's almost pointless.

I'd really support an increase in gynaecology provision in the UK. It would be counterproductive to absorb all of that in programmes such as reviews of symptomless patients with no evidence behind them.

UK survival rates for ovarian cancer aren't great in the context of Western European countries (though they weren't so bad until 2015 or so, pretty close to Germany and Denmark) and apparently that may well be due to high and historically early use of oral contraceptives, which reduces ovarian cancer risk. But I hope the ultrasound research a pp described is fruitful.

My experience in Italy with an annual appointment with a gynecologist (a woman by the way) allowed me to be referred early to a very good gynecologist (another woman) who had a special interest in endometriosis. This led to a very quick tentative diagnosis and laparoscopy to remove it. When I suspected a recurrence here in the UK, the care was very bad. The GP referred me for the wrong type of analysis, the sonographer didn't have a clue, I was finally seen by a good gynecologist and we decided to take a wait and see approach. However, she said there was no way to see her directly if my symptoms got worse - I would have gone through the same procedure of exams and referral. While probablt a yearly check might be unnecessary,I feel the lack of continuity of care problematic.

...I don’t agree at all that a yearly check is in any way not cost effective...

Which just proves you haven't done any research on iatrogenic disease and how this is a feminist issue.

Look up 'hysteria', look up 'childbed fever', look up 'the father of gynecology' - but not after you've eaten - look up 'drugs and electro-shock treatment' for bored housewives, look up blood clots and stroke and other side-effects of HRT.

I could go on but I'm sure everyone gets the drift. Physicians have always been dangerous to women.

They've got great PR, though. I'll give them that.

Regular checks can lead to discovering endometriosis, cysts, fibrosis in women. On ovaries, etc.
I feel like women healthcare in UK is terrible in comparison to Europe, and I don’t agree at all that a yearly check is in any way not cost effective, considering the operations and issues that would need to be treated by the NHS if an issue was discovered. Which it does and has happened to many of my fiends.
mad always it’s a way to ignore female health by using very basis and standard techniques.

dreamingbohemian yes that's the sort of context that we are missing.

Can't get on board with this whole "if you want to make someone feel comfortable and have a nice chat then best thing to do is stick your hand up their chuff" idea though, I must admit!

FairPhyllis WTAF?!

OK, so here is a small illustration of what weirdness ensues when you opt out of these checks. So as I said I did the opt-out of the screening program and sent it off earlier this week.

I've just received a letter this morning from the screening organisation informing me that my medical records indicate I no longer have a cervix (which is news to me!), and so I won't receive any more screening invitations.

This means that their pro forma letter (and presumably their system) only acknowledges not having a cervix as a valid reason to opt out. Just wanting to opt-out isn't recognised at all ...

But people used to feel there was a value in blood letting and routine episiotomies. You don't do stuff just because it makes the patient feel that you are doing something! More care isn't automatically better care!

It's unethical and in some cases harmful to do clinically unnecessary exams. You can educate without putting your hands up someone's fanjo. I get that it is a heavily ingrained cultural habit. But it is a feminist issue.

There was a post recently in Chat where the OP (who had grown up in the US) had had annual paediatrician checks as a child where the paediatrician visually and manually inspected her vulva and on one occasion when she was 12 felt inside her and proposed severing her hymen. Her parents were totally fine with this - and in fact let her be examined without a chaperone. As an adult she was having problems with massive fight or flight reactions in gynae situations. The resounding opinion on the thread was that this was abuse.

Now I know this is very far from normal even for the US. But the point is that if unnecessary exams are normalised, there's a huge potential for abuse, because people get confused about where normal professional boundaries for doctors lie, and abusers exploit this. And people do defer to doctors in a way they don't with other professionals. That is why there is a heavy responsibility on doctors not to do unnecessary procedures, even if the patient wants them to and even if it is something that was previously recommended. By refusing to do unnecessary exams you are protecting the patient - and yourself.

x-post Seven I do agree with you about the cultural divide, it makes things so hard to explain sometimes. I really can't explain the relationship many American women have with their gynos it's a very female-centric profession and it feels like a very safe space for a lot of women. You tell your gyno things you would never tell your GP. She cares about things your GP doesn't care about. She doesn't dismiss vague symptoms because sometimes that's all you get with women's health issues.

Obviously I'm idealising it a bit and there are terrible gynos out there too, but this is what a lot of women experience and that's why they go to the exams when they don't have to, in fact when they have to pay to go.

ACOG will protect the "annual" to make sure their members income is not compromised. IMO, there is too much money made from a women and her reproductive system, from the start of her periods to her eventual hysterectomy.

Seven, the way I read that is there is no quantitative evidence to support (or refute) the value of exams, but there is qualitative evidence in the sense that both doctors and patients believe there is a value to the exams that isn't captured in stats.

Many American women end up having very close relationships with their gynos, especially if they are ob/gyns and also deliver their children. It is so much more than just having a hand up your fanjo, you can get help for so many different things, including mental health.

For example, many women will not make an appointment with their GP if they feel depressed, but will open up about their depression when they have their yearly exam, and thus get referred to help. There is value in that but how do you capture that statistically?

There are so many issues here aren't there.

The cultural divide is huge - what people are used to - and of course people in the UK are very protective and defensive about the NHS

Clearly the US model has a lot of issues (don't know much about Obamacare)
NHS has issues as well obviously

As a British person who likes the NHS and feels it meets my needs and don't know anyone who has had anything major / missed / go wrong, I feel it is performing well. And am sceptical of more than what we get, based on what happens in different places with a different system and financial incentive for "more".
Conversely, for someone used to this, it's a case of, well it's the norm and sometimes it catches things which is great and you don't have to so what's the problem.

I do think that the history (and often the present!) of how the medical profession has treated women and their reproductive systems means it is a very good idea to pay attention to this stuff.

FairPhyllis I know this shouldn't be necessary but I've successfully avoided the smear test with my GP for 8 years (and counting) by being vague.

"Yes, of course, I know it's been a while, I'll make an appointment"
"Oh yes, sorry, I didn't get around to it. Yes I'll make an appointment"
"Oh sorry I thought it was a GP appointment I had to make for it" (this is a good one, it distracts them - in Australia GPs do them, here they seem to be horrified by the suggestion that they would do something that a mere practice nurse does)
"Oh I know but they're awful aren't they. Yes I will make an appointment"

And so on. I find pretending to frown upon the patient being troublesome (me) for not behaving seems to distract them from the fact that the patient continues to misbehave. Thus neatly using patriarchal assumptions against them. Things don't need to be discussed in order to be achieved.

And yes, it's appalling that such subterfuge is required, but I stopped trusting doctors a loooong time ago. The fact that they keep making you discuss it is bullshit and you don't need to give them respect, they've not earned it.

So actually here is the latest guidance from ACOG:

www.acog.org/About-ACOG/News-Room/College-Statements-and-Advisories/2014/ACOG-Practice-Advisory-on-Annual-Pelvic-Examination-Recommendations

They do recommend an annual physical which is all the other preventive health stuff, contraception etc. but not necessarily an annual pelvic. They still think there is clinical value in pelvic exams but says the patient and doctor should decide whether it's necessary to do them annually. That seems ok to me.

As for the education aspect, I think that is an ongoing process, not a one-time thing. Young women with many sexual partners, middle-aged women having children, older women approaching menopause, women have all kinds of different issues throughout their lives, in addition to all the things life throws you that you need support with (depression, addiction, etc.) These are all things that many women do not have enough information about, whether it's the biology behind it all or options for treatment.

dreamingbohemian the ignorance you talk about is appalling and the idea of gynaes educating women is fine but do they really need to stick their hands up their vaginas unnecessarily in order to do that?

ACOG say yes which is ridiculous. They actually state that there is no scientific basis for doing so, but carry on because it's a good conversation starter. I mean, really?!

That is all appalling dreamingbohemian (and the lack of knowledge is def not ltd to the us - it is still seen with depressing regularity in the uk) and I am sure the education received via a well woman check is great but I still struggle to believe that public health education rather than a genital and vaginal exam YEARLY is the way forward which is what the ACOG recommend. There just isn't any evidence that it is a useful procedure to prevent cancer or other pathology in low risk individuals and the OB GYNs should be highlighting this. They aren't. People just might need to be shown where a clitoris once (and I have my doubts). They don't need to be reminded every year. I do think intimate examinations in females are tolerated without question where they would not be in males. As a pp alluded to, people feel comfortable with the healthcare they are raised with. This doesn't mean it should not be questioned.

Can I throw in a cultural note here though, as an American?

I am not actually appalled by that statement because I know that sex education and general knowledge of reproductive health in the US is extremely dire in many places. There are huge parts of the country where students learn little more than abstinence and nothing about contraception. Abortion is barely still legal in many states, you can bet many young women don't know anything about it. There is essentially a culture that aims to keep women ignorant about their bodies, about sex, so that they will be good little submissive wives. Even in liberal parts of the country, Americans can be pretty prudish about sex.

I cannot tell you how many women I knew in my 20s who did not know what a clitoris was, who didn't understand basic biology, who thought if you jumped up and down after sex you couldn't get pregnant. THAT is appalling.

So yes, I can see why that statement sounds paternalistic, but there is no doubt that gynos do a huge amount of education in their work. It's not because 'women are dumb' it's because American women are purposefully kept ignorant and shameful of their own bodies.

I'm not saying all gynos are great or that there aren't problems in the system but to see them as part of the patriarchy just does not make sense to me. There are so many ways in which they are a corrective to the patriarchy as it exists in the US.

Off topic I know, but I have never understood the relationship between the Pill and optional cancer screening. IMO, any GP that holds contraception hostage until you agree to a smear test should go back to school to learn about informed consent.

I have a note on my records at my GP practice from the senior partner that I should not be provided with the pill unless I agree to a smear. Happy to prescribe without bp check, weight check or general history but absolutely essential that my cervix is swabbed for some reason.

Oh and I need counselling about whatever trauma I've experienced. No, I just don't want one. I've done my research, I've seen the damage caused to two of my sisters from unnecessary treatment. I'm happy with my position. I simply don't wish to have one. And when I do feel that it would be appropriate, I'll happily make an appointment with the Practice Nurse.

Needless to say the family planning clinic are much less backwards and were very supportive of me being an active participant in my healthcare.

Smear tests are different - the incentivisation may be questionable but the science is not completely absent. External genitalia examination and Bi-manual internal exams which are the standard annual test in the us (and other healthcare systems) is nonsense. This is a commercial and a feminist issue.

GPs are given an incentive to get every eligible woman up on the couch for a smear test. That is why women are harassed every time they pay the good doctor a visit.

I know - patronising paternalism much?! There was a big stink in America when the ACOG changed its guidance last year to suggest you don't have to do a pelvic exam on under 21s - lots of people saying they would be doing it anyway. It's nonsense and I really feel it is fee related. Anyone asking for annual penis exams to reassure of normalcy on a population basis?