AIBU to think I don’t need to go to the gynaecologist every year?!

[Watchagotcha]

I live in France but am from the UK. I was out with some friends last night - some French, mostly Brits who’ve been here a lot longer than me. We got talking about various medical issues, and it transpires that pretty much all my friends go to see their gynaecologist every year! I’m not sure what for: smear tests, when they are due; breast exams; and just “making sure everything is okay”.

Is this really necessary? What kinds of conditions might they be picking up on that I wouldn’t notice and go to the dr with myself?

Do I need to see a gynaecologist yearly?
YABU = yes you do, the gynaecologist might find something that needs treated
YANBU = no, don’t be daft, go to the dr if you need to and get regular smears when they are due

I don’t get smear tests but I do have an annual gynae check up. (privately)

Well I've never been to a Gynae either. I always have a regular (3 yearly) smear, I never had issues with periods, or conception, or any other gynae problem, so why really bother? I suspect over-treatment with financial reward is a factor in yearly testing.

This article is interesting - smear tests in the future will be every 5 years, and will be able to be done at home!

www.newscientist.com/article/2192994-recommended-gap-between-smear-tests-could-increase-thanks-to-hpv-test/

I think uk (nhs) has the double whammy of less regular check ups and gate keeping gp services that make referrals slow and difficult.

I think uk (nhs) has the double whammy of less regular check ups and gate keeping gp services that make referrals slow and difficult.

My referral to the breast clinic was within 2 weeks after a same day GP appointment to check out my concerns. They did a multitude of tests. On the whole, I was satisfied with the treatment the NHS gave me for breast cancer.

I do think the NHS gets a lot of unfair press. The thing is with gatekeeping and triage is that you have to prepared to effectively communicate about your concerns with receptionists, nurses etc as well as the doctors or surgeons. That way they can prioritise your treatment appropriately. When people don't they end up waiting to be seen initially and subsequently are referred later.

I'd love to have an annual health MOT.

The thing is with gatekeeping and triage is that you have to prepared to effectively communicate about your concerns with receptionists, nurses etc as well as the doctors or surgeons.

but many are not able to do that. or not forceful enough. or are fobbed off with ibs for ovarian cancer symptoms...

but many are not able to do that. or not forceful enough. or are fobbed off with ibs for ovarian cancer symptoms...(

True. But I sort of prefer that to the alternative of a higher number of routine check ups. As other posters have pointed out, there are pros and cons with each system and non medical reasons affecting how each system is organised.

Ultimately, some people feel safer with more check ups and it makes some people feel less safe due to the generally perceived need for a check up triggering worry and health anxiety.

My conclusion is the comparative safety is a completely arguable point. I think it is unfair to pressure people one way or the other.

@Watchagotcha Apart from the gynaecologist, I don't see how that list would be any different if you were in the UK? You forgot dentist too, though I guess that doesn't have a satisfying 'ogue' at the end to illustrate the "excess" of health care you're inundated with

I never did. I have heard it is standard practice in the USA. The only time I ever saw a gynaecologist was when I had a little problem which turned out to be a cervical polyp and I eventually had that removed. Smear tests were done at the GPs surgery every three years.

However there's something about the annual invasive stuff for girls from young that feels like a hangover from the idea embedded years ago and seemingly not eradicated that women's reproductive system is problematic
To be honest, I perceive it completely in a different way - from an outsider's perspective, there are some distinct echoes of Victorian attitude to "lady problems" in Britain. I have seen some (male) GPs who used euphemisms like "how are you feeling down there". Errr, down where exactly? Shall I point where it hurts on a doll?

The annual invasive stuff is not compulsory, it is offered and is free (not only in school, but for uni students as well, as long as they are in education). It does not only cover gynecologist for females, males are seen by an urologist as well, and both sexes see an array of other doctors, from ophthalmologists to mental health nurses. Boys have it more "intrusively", if anything, as the same annual check ups from a certain age include assessment of fitness for military service (which is compulsory, unlike other checks).
Nothing is compulsory for adults, but the majority of women I know carry on the habit of having annual check ups.

Annual gynaecology check-ups are common on the continent and it's just a money making thing for the gynaecologist. We don't do them here for good reason.

@waterbottle12 we don’t do them here coz it’s too expensive ! However, in an ideal world everyone should have an annual health check and a smear plus breast exam would form part of that.

@Strongmummy there is absolutely no evidence that annual smears or breast exams do any good other than for the Bank balance of the doctor. I'm a GP and overdiagnosis is a massive issue that we should all be aware of.

@waterbottle12 you’re a GP in the NHS I’d assume. Therefore of course it won’t be cost effective! I have an annual health check privately and as part of that I have a breast check and smear. I’d rather be overdiagnosed than not diagnosed at all ! My mother’s cancer would not have been spotted under the current NHS guidelines for breast exams. Please remember we aren’t stats, we’re individuals

Annual gynaecological exams for women in the USA and other countries are a very profitable business stream. If you convince women that their reproductive system needs yearly surveillance you will always have customers.

You start grooming your victims from a early age to condition them that penetration with speculums and fingers is perfectly reasonable (even before they are sexually active) and anyone that says otherwise is not looking after their health.

Revenue is provided by -

Puberty checks
Period questions
Sex life interrogation
Contraception
Pelvic exams
Cervical screening
C-sections
Breast screening
and finally a hysterectomy - but you still have annual pelvic exams and "vault" smears , just in case.

As long as you are alive, you are a cash cow.

I’d rather be overdiagnosed than not diagnosed at all

and that's your right to take the risk of significant damage from overdiagnosis. It remains that fact that annual checks do no benefit other than reassurance. If you want to pay for that then fine, someone has to pay for the gynaecologist's skiing holiday! But there is zero evidence for benefit of an annual breast examination or for annual smears for most women.

Where I am a gynaecologist would run (public) clinics in hospitals where women are treated for specific issues. If and when that issue is resolved the women is discharged from the clinic and a letter sent to her GP saying if there are further issues to rerefer.

I'm sure of you're paying for a private gynaecologist they'll happily see you as often as you want to go. But the GP can do smears, no need for a gynaecologist for that. If further investigations are needed you will be referred on. If an issue is ongoing you will get regular (6 monthly, yearly followups). If there is no ongoing issue there is no reason to see a specialist.

women's drs in many countries are not just gynecologists.
in germany for example they are generalists for women's health. yes, they do smear tests, but they also do ultra sounds and other checks for pregnant women, bone density scans, birth control advice& prescription, abortions, breast checks and mammograms...

If my friend had had a proper examination, rather than being fobbed off with 'women's problems, what do you expect?' Her ovarian cancer would have been detected.

I think the French attitude that women shouldn't 'expect' incontinence or sexual problems after childbirth is actually very refreshing. Being able to see a specialist in women's health yearly would be a fantastic thing.

The Americans are obsessed with fannies. Or, more precisely, making money from them.

How does your average patient (let alone one who has some kind of learning disability, mental health problem or confusion) know where to refer themselves?
Shoulder pain - see a physio next week or a gynaecologist RIGHT NOW because it could be an ectopic pregnancy and life threatening?
Chest pain - pulled muscle or angina?
Sore toes - slipped disc? Diabetic issues? Or is that glass you dropped in the kitchen somehow embedded in your foot?

Being able to see a specialist in women's health yearly would be a fantastic thing

Nothing is stopping you. These tests are paid for. Go and see one privately if you want, they'll be happy to take your money for an easy appointment.

stripey
Maybe not the bone density but all the rest are gynae issues but also several of them are things that GPs do in the UK, so the extra money spent training gynaes isn't wasted on day to day issues.

I don't think the 3 yearly thing for smear tests is down to money (or lack of it). If you have a private health screening and you've had a smear test fairly recently, they don't do it again and say the labs won't do the testing because of protocols. If it were purely down to £££ they wouldn't care about doing it again if you were paying for it.

Anyway every 3 years is quite enough for me and after the next one it will be every 5.

In Cyprus my doctor was aghast at the 3 yearly policy of smears in the uk ... this was NHS hospital so not a money thing either, he said it very much is a money thing for the yo though. You get a smear done there by a gyno so yes you'd visit yearly