There are several important implications of not doing routine pelvic examinations. First, many women, especially reproductive-age and minority women, use their obstetrician/gynecologist (OB/GYN) as their primary caregiver (60). Data from the National Ambulatory Medical Care Survey showed that 57.8% of nonillness ambulatory visits for women aged 18 to 44 years and 34.7% for women aged 45 to 64 years were with an OB/GYN provider (61). One study showed that among women aged 18 to 40 years, 65% feel most comfortable with their OB/GYN, and women who use OB/GYNs for their primary care, either alone or in combination with a generalist physician, are more likely to receive reproductive preventive health services (60–61). Women may stop coming in for preventive care for their reproductive health other than when their Pap is due and
miss regular screening for sexually transmitted infections, breast cancer, domestic violence, and substance abuse; contraceptive and dietary counseling; immunization updates; smoking cessation discussions; and mental health support. Second, I have concerns that this recommendation could be used to limit health insurance coverage for well-woman examinations. Finally, I worry about a decline in health care provider skill in performing comfortable, complete pelvic examinations, because physicians need to do a certain number of pelvic examinations to maintain competency. Residents need to be trained in pelvic examination by physicians who are skilled with the examinations. In obese patients, pelvic examinations are more challenging, and we may find ourselves unable to locate the cervix when doing cervical cancer screening every 3 to 5 years, because we've lost our skills.