You Don’t Need to See a Gynecologist Anymore

Except…you do.

Many women who have had a hysterectomy are told that they don’t need to return to their gynecologist because they won’t need PAP smears anymore.  This makes me s/mad because gynecologists do more than provide PAP smears.  Except…some gynecologists don’t know that.  Gynecologists are vulvovaginal experts.  They are who you go to if you are a woman with a sexually transmitted disease, they are who you go to if you have a vulvovaginal infection and they are who you go to to get your vulva screened.  ‘Cuz, believe it or not, you can develop vulvovaginal issues without a uterus or cervix.  It’s true!

Lately I’m seeing an increasing number of women who aren’t getting proper vulvar screening after a hysterectomy.  Looking at the vulva – actually, having someone else look at the vulva is vital.  Lots of issues can result overtime, unnoticed and ominous in nature.

Please, allow me to list my two main grievances:

Grievance One:  The vulva must be checked after hysterectomy because women go through menopause.  When a woman goes through menopause, her sex hormones drop.  When sex hormones drop, the genitals can shrink.  Some of this shrinkage doesn’t create any symptoms.  Other times, the shrinkage causes pain or becomes dysfunctional.  The clitoris can get really small and painful.  The labias can start to resorb into the rest of the vulvar area.  The opening of the vagina can get really sensitive.  The genital tissue can get dry and thin and can crack easily creating pain, bleeding and more avenues for true infections.  And then there are the mock infections.  When the external genital area on a woman (the vulva) and the inside (the vagina) shrink and wither, this is called atrophy.  This can create pain with pressure or friction in the vaginal canal.  This can feel like painful sex or painful gyno exams (that you aren’t having because you have been told not to go to the gyno anymore) and painful sitting even!  But, you won’t know why you have these weird feelings because no one is inspecting your genitals anymore.

Grievance Two:  Your vulva has some skin.  Between your legs there is skin!  And skin can have skin disease!  So, the biggest ones you will hear about are Lichen Sclerosus and Lichen Planus.  These can cause shrinkage, resorption and/or disappearance of parts of the genitals.  These disease processes, if left undiscovered and untreated can create pelvic pain.  They can also do crazy things like, in the worst cases, close the opening of the vagina.  In some cases these skin diseases can even cause cancer.  But, again, if you stop going to the gynecologist to have a thorough vulvar screen, you may never know what’s going on.

How do I know this happens?  Well, because I see it.  I see it in my clinic.  I’ve had women who haven’t had anyone, not just a gyno, but any experienced eye look at their vulva in seasons, nay – years, nay…decades even.

So while it’s encouraged, awesome and neat that women are looking at their own vulvas more, what is additionally necessary is that a discerning healthcare provider look at the vulva too.  In the most extreme cases – it could save your life.  In some of the less extreme, but still extreme cases, it could save your quality of life.

And that is that.

If you have any questions or comments, please leave them anonymously in the comment section below or email me at [email protected]  I will respond to them, I promise, I’ll get my rear in gear and do it.

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10 thoughts on “You Don’t Need to See a Gynecologist Anymore”

  1. This is exactly what I was told after my first hysterectomy at 40 yrs. old for a 5 pound fibroid tumor. Ten years later, I had my “2nd hysterectomy”(oophorectomy-didn’t know I even had fallopian tubes or ovaries because I was told I had a TAH)! I had a positive ovarian cancer test and endometriosis and didn’t even know until one of the ovarian cysts ruptured and I felt pain. Thankyou for being thorough in your practice!

  2. Thank you, Sara. Women will come to PT with diagnosis of pelvic pain, vaginissmus, levator ani syndrome, etc. The tissue will look suspect to me and I ask them to see a gynecologist and I have to choose to hold off PT until they rule out LS or LP. I am then informed that they haven’t had an exam in years and they were told, “you don’t need to see a GYNO anymore!” Well, how did your provider discern your diagnosis? In our rural community, the PA’s and NP’s are very skilled, so if the MD’s are busy, patients will get a thorough exam by a knowledgeable provider. Thank you for this post and I can now educate my patients on the importance of screenings. See you in May!
    AnnaKate Moore, PT, DPT
    Bishop, CA

    1. A correction to your statement: there has never been any recommendations that have said that you flat out don’t need to see a gynecologist again. The American College of Physicians and the American Academy of Family Physicians both have recommended against routine pelvic exams, if a woman isn’t pregnant, has good health, and has no pelvic symptoms (Pain, swelling, lesions, bumps). The USPSTF has also came out with a rating of “I” on routine pelvic exams and are continuing to do further studies on the benefits of these exams. The ACOG has made a statement that they still believe that an annual pelvic exam is necessary but it should be a shared decision between the patient and the Doctor. It the patient isn’t given the information about pelvic exams and how to identify pelvic symptoms, then the decision to have a pelvic exam will be the Doctor’s only.
      Doctors have taken advantage of ignorant women for years, even though the pap smear has been changed to every 3-5 years. Women should be treated with respect and when they are badgered into the stirrups without medical justification, this is abusing the patients dignity and charging $100.00 or more per visit. I believe that women should discontinue going to a gynecologist, when they are done having babies. Only go to a gynecologist when there are pelvic symptoms. GPs will almost never do a routine pelvic exam unless the patient requests it.

  3. I know that there are some extreme exceptions but it you learn what to feel and look for, pelvic symptoms the following apply:

    There is good news for some of you. In 2014 New recommendations from the American College of Physicians and American Academy of Physicians both recommend against routine pelvic exams for healthy women, who aren’t pregnant and don’t have pelvic symptoms. This was decided after doing some extensive resource on routine pelvic exams. You still need to have pap smears, every (3) years. Check it out for your self. Don’t go to your Gynecologist after your are done having babies. They won’t ever tell you about the new recommendations, as they will still want to see you in the stirrups each year. They want to protect their business at your expense and embarrassment. They make an additional $150.00 or more, each time they can get you in their stirrups. Your general practitioner will not push you into a routine pelvic exam, unless you request one. Please check this information out for your self. Your will be glad you did. Take control over your body. Learn how to check for pelvic symptoms and give yourself a basic pelvic exam if you are still a bit skeptical.

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