The question of when to stop having pelvic exams is more complex than a simple age cutoff, as it involves two distinct procedures: the physical exam and the specific screening tests for cervical cancer. A pelvic exam is a broader assessment of the reproductive organs, while cervical cancer screening is a targeted test for precancerous changes. For average-risk individuals, medical guidelines suggest discontinuing the cancer screening component around age 65. However, the need for the physical examination portion may continue indefinitely based on individual symptoms and health history.
Distinguishing the Pelvic Exam from Cervical Cancer Screening
The term “pelvic exam” is often used interchangeably with “Pap test,” but they are fundamentally different procedures with different purposes. A pelvic exam is a physical assessment that typically consists of two parts: the external and speculum exam, and the bimanual exam. The speculum exam allows a healthcare provider to visually inspect the vulva, vagina, and cervix for signs of infection, inflammation, discharge, or lesions.
The bimanual exam involves the provider inserting two fingers into the vagina while pressing on the lower abdomen to palpate the internal organs. This manual check evaluates the size, shape, and position of the uterus and ovaries, helping to detect non-cancerous issues like fibroids, ovarian cysts, or tenderness. The physical exam looks for general physical abnormalities, masses, or sources of pain.
Cervical cancer screening includes the Pap test (cytology) and the Human Papillomavirus (HPV) test, which are laboratory procedures that collect cells from the cervix. The Pap test checks for abnormal or precancerous changes in these cells. The HPV test looks for high-risk strains of the Human Papillomavirus, which causes nearly all cervical cancers. Although cell collection occurs during the speculum exam, the screening itself is a focused test for cancer prevention, not a general reproductive health check.
Guidelines for Discontinuing Routine Cervical Screening
Medical organizations like the U.S. Preventive Services Task Force (USPSTF) and the American Cancer Society (ACS) recommend that individuals at average risk may stop routine cervical cancer screening at age 65. This recommendation is based on the low probability of developing a new, clinically significant HPV infection or cancer after this age, provided a person has a history of adequate negative screening results.
To safely discontinue screening, a person must meet criteria demonstrating a consistently low risk over the preceding decade. Adequate prior screening requires either three consecutive negative Pap tests alone, or two consecutive negative co-tests (Pap and HPV tests performed together). These negative results must have been obtained within the last 10 years, with the most recent test occurring within the last five years.
A person must also have no history of a high-grade precancerous lesion, specifically Cervical Intraepithelial Neoplasia grade 2 (CIN2) or greater, within the previous 20 to 25 years. If such lesions are present, screening must continue for at least 20 years following diagnosis and management, even if this extends screening past age 65. Women who have had a total hysterectomy for benign conditions, including the removal of the cervix, can also discontinue screening since the target organ for cervical cancer is no longer present.
Factors Requiring Continued Physical Pelvic Exams
Even after meeting the criteria to stop cervical cancer screening, the physical pelvic exam often continues, especially if symptoms arise. The physical exam is a diagnostic tool for non-cancerous conditions not detected by a Pap or HPV test. The risk of other gynecologic cancers, such as ovarian, uterine, vaginal, and vulvar cancer, continues or increases with age, making symptom assessment important.
Any unexplained symptoms, such as post-menopausal bleeding, chronic pelvic pain, unusual discharge, or a new lump, immediately warrant a physical pelvic exam regardless of age. Post-menopausal bleeding, in particular, is a symptom that requires prompt investigation for conditions including endometrial hyperplasia or uterine cancer. The bimanual exam also helps monitor for changes in the size of the uterus or ovaries, which is important for individuals with a history of conditions like uterine fibroids or ovarian cysts.
The physical exam is also important for evaluating pelvic support, as pelvic organ prolapse is common in older, post-menopausal women due to loss of tissue elasticity. A provider can check for a cystocele or rectocele, which may contribute to bladder or bowel issues. Individuals who continue to use an intrauterine device (IUD) for contraception or hormone management still require periodic physical exams to ensure the device is correctly positioned.