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

@StrongMummy

I'm glad for your Mum. She is the 1 in 200 that have their life saved by cancer. In the same cohort of 200 women, 3 will be diagnosed with something that would never have caused them problems in their normal lifespan and will have unnecessary treatment, which can come with significant side-effects and sometimes cause death. It isn't straightforward

www.nhs.uk/conditions/breast-cancer-screening/why-its-offered/

@nespressowoo it takes around 10-15 years for early changes to turn into cervical cancer. Annual smears are an utter waste of time so unless you enjoy speculum examinations I can't imagine why you would want them. If early changes are found then you'll be moved onto annual smears. With the advent of HPV screening (because of course cervical cancer is largely sexually transmitted via HPV) smear frequency will probably get lower in future years.

Annual smears are an utter waste of time so unless you enjoy speculum examinations I can't imagine why you would want them.

waterbottle I think the answer is that many people do enjoy them, maybe not the speculum part as such, but they love going to the doctor and being fussed over and asked to talk about themselves.

Annual smears are an utter waste of time so unless you enjoy speculum examinations I can't imagine why you would want them.

waterbottle I think the answer is that many people do enjoy them, maybe not the speculum part as such, but they love going to the doctor and being fussed over and asked to talk about themselves.

I think this just highlights how the health advice depends not on what is best for the individual or even population health. It is much more complex and political than that. And in turn this affects people's perceptions of what is the best course of action for health generally.

It is one reason I believe the NHS is better than private healthcare. With the NHS (as long as you have capacity) you can decide to opt out of any proposed treatment or procedure, if you so wish, without the added worry about insurance premiums or losing the right to be treated.

I don't enjoy the examination or being fussed over. It's the reassurance. A friend had a clear smear and three years later need treatment for cell changes. Three years is a long time.

YANBU in terms of frequency.

However, I wish it was standard for all women to see a gynaecologist here in the U.K. Maybe the diagnosis times for conditions like endometriosis wouldn’t be so long. Having said that I’m not sure they’re both shorter in the US or countries where gynae visits are standard?

To be honest things could be improved if GPs weren’t so dismissive of women’s health issues, pelvic pain, abnormal periods etc.

nespresso, your friend, though, was only treated for cell changes. Not actual cancer. So she was treated well in time. That's with three years between tests.

Smears are performed every three years in the US, not annually. Mammograms after 40 are strongly encouraged, even without family history. Saying that, I’ve only been for one and I’m 43. It hasn’t in any way affected my insurance policy.

I saw an OBGYN just once when I lived in England. I was 21 and had endured horrific periods for years. I had read a great deal about PCOS and wanted an ultrasound and the specialist said I was “much too thin” to have PCOS and that was that. Moved to America at 25 and was diagnosed almost immediately.

In the UK, seen my gynae once a year since I was 16 for a check up, everything related to that area and birth control etc.

I don't enjoy the examination or being fussed over. It's the reassurance.

Its false reassurance though as the science doesn't back up that frequency of tests. You could equally reassure yourself by reading a few scientific papers about it.

As veryvery points out your friend got treated for cell changes not cancer so the three year frequency was fine in her case.

Smears are performed every three years in the US, not annually.

I get one annually in the US. My insurance pays for it, I don't have a copay for it, so I get one. 🤷

Annual smears are an utter waste of time so unless you enjoy speculum examinations I can't imagine why you would want them.

The point is, my gynaecologist doesn't just do a smear. There's more elements to the checkup which could pick up other issues, not just cervical cancer.

I think the answer is that many people do enjoy them, maybe not the speculum part as such, but they love going to the doctor and being fussed over and asked to talk about themselves

I don't particularly feel like I'm "fussed over" by my gynaecologist. And I'm not waxing lyrical about my vagina during the whole appointment. I can't say I enjoy it, but I appreciate that it's there to make sure I'm healthy.

Also, it's usual to go once a year, but it's by no means compulsory! Insurance and access to health care are unaffected if you choose to go less often.

Interesting that someone further up the thread said that a teenager could ‘just refuse’ a pelvic exam if they didn’t want one. This ignores the massive imbalance of power in the situation. It’s really not that straight forward.

Even as an informed adult I found it difficult to say ‘no’ to a smear. The GP in question then proceeded to use emotional blackmail on me with the story of some great aunt of his that had died of cervical cancer. It was all highly unprofessional and I really wish I’d reported him.

This is very interesting regarding breast screening.

I haven't had a smear since shortly after my DD was born. She is 23.

Pay per visit is a powerful driver of non evidence based medicine.
For those who think “ it does no harm “ I would question that. You will get more false positive tests and treatments that will harm some people will be done - eg biopsies Of lesions that will never be one significant - or even the psychological harm of the anxiety whilst waiting for results that can be significant in some people.

@1300cakes I have a smear annually. I’ve had abnormal cells 3 times in my life and I watched my mother in law die horribly and painfully of cervical cancer. Trust me I don’t enjoy them, however, my annual check provides comfort and the knowledge I’m highly unlikely to get cervical cancer.

@shamalidacdak do you want a prize?

I am in my 40s and have never been. I do have smear tests but it’s done by a nurse.

@Helenluvsrob don't forget the extra radiation from treatment for cancers that would have gone away by themselves.

I'm in my late 50s and have two children and have also never seen a gynaecologist. Quite happy with that.

I've always had smears done by practice nurses (now only every 5 years because of my age) and I have mammograms every 3 years. I also had a general health check up recently (general chat to ask about levels of drinking and smoking, plus check of weight, blood pressure and cholesterol levels).

I would hate to think of my daughters having internal exams when they were teenagers.

More generally, I was very interested in the comments by @waterbottle12 about problems caused by over diagnosis.

It's pretty standard anywhere that health are isn't completely free. I think the UK goes too far the other way, though, and makes all issues that arise with age something to be endured. Menopause is undramstic for me but I am hypermobile and didn't twig until it started causing me some real pain at 40. GP dismissed it as to be expected at my age and it took a young locum to get a referral.

I was actually pretty shocked recently to learn that yearly gynaecologist visits in the US begin as a teenager, and that they regularly carry out internal exams from that age even if there are no symptoms that would make that medically necessary.

Where did you learn this?

I'm in the US. I have teen daughters age 16 and 18. They are both on the pill to help reduce period pain. Neither has ever had an internal or a smear, and they won't until they're 21, which is when they're recommended to begin. At that point they're recommended every 3 years.

kidshealth.org/en/teens/pelvic-exams.html
"Teens don't usually get pelvic exams. Sometimes doctors do pelvic exams if they think there's a problem. For example, if a girl complains of heavy bleeding, missed periods, or discharge, the doctor will want to check for a cause. Otherwise, doctors don't recommend regular pelvic exams or Pap smears until a woman is 21 years old."

My GP does my smears every 3 years, and he checks my ovaries at the same time. Other than that I don't have any 'internals'. No one checks my breasts for me.

None of us has ever seen a gynaecologist. We all just see our GPs. If we needed to see a gynaecologist then our GP would refer us. We could also choose to have a gynaecologist as our primary care provider if we wanted, which isn't a bad idea for females, but none of us has felt the need.

I get a mammogram every 2 years and have done since I was 40. I get bone density tests every 5 years because I'm on the depo-provera shot.

I see specialists if I need to - usually the GP refers me, and it's to one that he recommends and that my insurance covers. Most specialists in my area of the US do want a referral from a primary care provider. I couldn't speak for other areas.

I see mine every 3 months unfortunately, obviously I’m not in great health. As a lot of sexual health clinics have been closed I presume gp surgeries do smears and women who see gynaecologists either pay privately or have been referred and therefore have problems that require checking up on once a year. If you don’t, your lucky!

I always think this is an interesting question.

Go more frequently with the risk of over diagnosis or less with the risk of having, let's face it, cancer.

For me the treatment for aggressive cancers looks so barbaric with the increased risk of secondary cancer that I would go less frequently. I do understand that as individuals we have our own concerns, priorities and anxieties. I don't think that women who would get checked more necessarily enjoy the speculum or mammogram or attention. It's just personal requirements from healthcare, and we are lucky if what we are offered suits us and our time and money constraints.