Do I really need a pelvic exam?
Heather Corinna replies:Why is a pelvic exam really necessary? I am sexually active, but my boyfriend and I have only ever done anything sexual with each other, and neither of us have anything. I've asked this question to other people and they always say that "You don't KNOW," or that I shouldn't just take my boyfriend's word for it. I trust him, so I'm not considering that part, so ignoring a possibility of disease (which I doubt there is any), why is it so important that I have a pelvic exam?
The thing is, other things can go wrong with your reproductive cycle that have nothing to do with sexual activity.
Things like ovarian cysts or PCOS, irregular menstrual cycles or unexplained vaginal bleeding, yeast or bacterial infections, endocrine imbalances, urinary tract or bladder infections and more are all issues which women who have never even had one sexual partner may experience. They are also issues which can occur among sexually active women when neither partner has or is exposed to a sexually transmitted infection.
That's why some regular, preventative reproductive healthcare is recommended even for women who have never been sexually active. A pelvic exam -- rather than tests for sexually transmitted infections -- is simply a checkup of your reproductive system like a yearly visit to the dentist is a checkup of your teeth. During a pelvic or bimanual exam, a healthcare provider is just going to do a visual exam of your genitals, then just use gloved fingers to feel your uterus and ovaries to be sure everything is okay.
If you are sexually active -- and for some doctors, even if not, once you're over anywhere from 16 to 25 (guidelines vary) -- you may also get a pap smear, which is a swab of your cervix to check for cervical cell changes which can alert you and your doctor to cervical cancer risks and other issues. As we know so far, cervical cancer is primarily related to the human papillomavirus (HPV), but it may not always be. The jury is still out there. As well, if you are sexually active, a sexual healthcare professional should be doing STI tests with some regularity: at least once every year or two, or more often for women who are switching partners more often than that. If you and your boyfriend have only ever been with each other, for real, you're right: your STI risks are very minimal, and probably limited to infections which can be sexually transmitted, but which also can be contracted through more casual contact, like oral herpes (which can also be transmitted genitally through oral sex) or pubic lice.
However, your friends have a salient point, which is that we can never completely know if and when a partner is both remaining faithful and is being honest about never having had previous partners: the hard truth is that even the people we love and trust will not always be honest, especially when the stakes are high. By all means, we want to trust our partners, but we can still be trustworthy while also getting the tests we should to assure our continued health. A partner's word isn't a test and it isn't preventative healthcare. If I had a dollar for everyone I've counseled over the years who got an STI from a partner they were assured presented no risks, and with whom they decided that trust somehow negated a need for healthcare, I'd be doing much better financially than I am right now. (And some of that has to do with the fact that two partners assured they are each other's firsts also will less often be sure to use latex barriers for oral, vaginal and/or anal sex.) Why not combine that trust with tests? As well, if you're in your teens, know that your risks of some infections or complications from some infections -- even something like a basic bacterial infection -- are higher because your cervix has not yet finished developing, which makes it more suceptible to infections and complications.
So, the best bet for anyone is to practice safer sex -- which includes getting a pelvic exam for you and STI testing for both of you -- for at least the first six months. If after that six month period, you both test negatively, and remain monogamous, you can consider going without barriers and reducing how often you get that testing. How infrequently you get tested is just one of those things which is up to you. I personally encourage everyone to just get in the habit of tests and exams each year -- especially since given you are young, it's unlikely this will be your only partner, so you're probably going to need to get into that habit eventually. Once you get in that habit, you'll find out that those exams really are no big shakes, and it won't seem like such a huge deal.
I don't know how old you are, but if you were in your teens and had never been in any way sexually active, it's usually okay to go ahead and wait to pelvic exams and pap smears until you are, unless you experience things like very painful periods or uterine or ovarian pain at other times, excess or unexplained bleeding, absent periods after your cycle has regulated, pain when urinating, strange discharges, genital sores or suspected pregnancy. But since you are sexually active, you really will want to start your exams, both because again, trust is a big deal, but it doesn't actually provide any protection and because sex does create risks for your reproductive health, no matter how you have it or with whom, that you want to be proactive about when it comes to being sure your sexual health is up to par.
Here are a few links to round this all out for you: