Quick Answer
Generally, you do not need routine pelvic exams if you have had a total hysterectomy (removal of the uterus and cervix) and you don’t have a history of pelvic cancers or other pelvic issues. However, you should still see your gynecologist regularly for preventive health care. They may recommend a pelvic exam if you have symptoms or health concerns that need evaluation.
What is a Pelvic Exam?
A pelvic exam is a routine part of the well-woman visit to the gynecologist. It allows the doctor to visually examine the vulva and vagina and manually examine the internal pelvic organs including the vagina, cervix, uterus, and ovaries.
The exam has three components:
- Visual inspection of the external genitals for signs of infection, irritation, cysts, or growths.
- Insertion of a speculum to open the vagina and examine the vagina and cervix.
- Bimanual palpation where two fingers are inserted into the vagina and the other hand presses on the abdomen to feel the shape and size of the uterus and ovaries.
In addition to evaluation, a pap smear for cervical cancer screening is often collected during the pelvic exam.
Do you need a pelvic exam after a hysterectomy?
If you have had a total hysterectomy, which involves surgical removal of the uterus and cervix, you most likely do not need to continue having routine pelvic exams.
Here are some things to consider:
No cervix = No pap smears
A major component of the pelvic exam is the pap smear to screen for cervical cancer. Once your cervix is removed, there is no need to collect pap smears.
Current guidelines recommend women ages 21-65 get pap smears every 3-5 years. If you had your cervix removed before age 65, you can stop getting pap smears.
No uterus = No bimanual exam
There is no need to do a bimanual palpation to examine the size and shape of the uterus if your uterus has been surgically removed.
Bimanual palpation may still be recommended if you retained one or both ovaries to examine for ovarian cysts or masses.
No symptoms or concerns
If you have had a hysterectomy and are not having any pelvic symptoms like pain, bleeding, or discharge, then a pelvic exam offers no clinical benefit.
A pelvic exam in asymptomatic women post-hysterectomy would only lead to unnecessary tests and procedures.
When should you still get pelvic exams after hysterectomy?
There are some situations where a pelvic exam may be recommended after hysterectomy:
Previous history of gynecologic cancer
If you were treated for ovarian, cervical, uterine, or other gynecologic cancer in the past, your doctor will likely want to continue periodic pelvic exams to monitor for cancer recurrence.
Strong family history of cancer
If you have a strong family history of gynecologic or breast cancers, your doctor may want to continue exams to screen for any new cancers. This includes BRCA gene mutation carriers.
Pelvic symptoms or issues
If you develop any symptoms or issues like:
- Vaginal bleeding or discharge
- Pelvic pain or pressure
- Pain or problems with intercourse
- Bladder control issues
- Pelvic organ prolapse
Then a pelvic exam is warranted to evaluate these concerns. Your doctor will examine the vagina and may recommend tests like ultrasounds, CT scan, or MRI.
Need for contraception
If you are sexually active after hysterectomy and don’t want to get pregnant, you may opt for long-term contraception like an IUD. Insertion and monitoring of the IUD will require pelvic exams.
Hormone therapy monitoring
If you are on hormone replacement therapy after hysterectomy, your doctor will want to monitor the effects with an occasional pelvic exam.
Should you still see a gynecologist after hysterectomy?
Many women wonder if they still need to see a gynecologist after getting a hysterectomy.
It is recommended to continue routine gynecologic exams and preventive health care, even after hysterectomy. Here are some reasons why:
General preventive care
Your gynecologist provides all aspects of your female healthcare beyond just pelvic issues. This includes:
- Breast exams
- Screening mammograms
- Management of menopause symptoms
- Osteoporosis evaluation
- Counseling on heart disease, diabetes, weight management
- Immunizations
- Cancer screening
They can coordinate this preventive care annually.
Ovarian cancer screening
If you kept your ovaries after hysterectomy, regular gynecologic exams give the opportunity to screen for ovarian cancer. This includes physical exams, ultrasounds, and CA-125 blood tests if indicated.
Sexual health
Your gynecologist can address any sexual concerns after hysterectomy and postmenopausal changes that affect libido and vaginal health. This includes evaluating and treating vaginal dryness or pain with intercourse.
Emotional support
Your gynecologist has been with you through your major surgeries and treatments. Having that continuity of care and source of support can be beneficial. They understand your history and needs.
Hormone therapy
If you take hormone replacement therapy, your gynecologist will manage this and monitor for side effects with an annual visit.
The bottom line
While routine pelvic exams are likely not necessary after a total hysterectomy, you should still see your gynecologist for overall health maintenance and preventive care.
If you have any pelvic symptoms or issues after hysterectomy, your gynecologist can evaluate you and perform an exam as needed. Be sure to follow up annually and get all recommended screening tests.
Gynecology Visit Recommendations After Hysterectomy
Here is a summary of gynecology visit recommendations for women who have had a total hysterectomy:
| Procedure | Age 21-29 | Age 30-39 | Age 40-64 | Over age 65 |
|---|---|---|---|---|
| Pelvic exam | Only if symptomatic | Only if symptomatic | Only if symptomatic | Only if symptomatic |
| Pap smear | No | No | No | No |
| Breast exam | Annually | Annually | Annually | Annually |
| Mammogram | No | Baseline at 35 | Every 1-2 years | Every 1-2 years |
| Ovarian cancer screening | No | Discuss with your doctor | Discuss with your doctor | Discuss with your doctor |
| Bone density screening | No | No | At age 65 | Every 2 years |
| Colon cancer screening | No | At age 45 | Every 10 years | Every 10 years |
Key Points
- No pelvic exams are needed unless you have symptoms or concerns
- You no longer need pap smears
- Continue breast cancer and general health screenings
- Discuss ovarian cancer screening with your doctor if ovaries remain
- Have an annual visit for overall preventive health care
See your gynecologist for any issues like vaginal symptoms, bladder problems, sexual health concerns, or menopause management. They can perform a focused exam if needed.
Frequently Asked Questions
Do you still need Pap smears after hysterectomy?
Pap smears screen for cervical cancer and pre-cancer. If you have had a total hysterectomy with full removal of the cervix, you no longer need pap smears. Guidelines say pap smears can stop after complete hysterectomy.
Can a doctor tell if you’ve had a hysterectomy without exam?
In most cases, the doctor can determine if you’ve had a hysterectomy from the patient history and medical records alone without needing to perform a pelvic exam. The main exam clue that a hysterectomy was done is the absence of a cervix.
What problems can occur after a hysterectomy?
Some common issues after hysterectomy include:
- Menopausal symptoms – hot flashes, vaginal dryness
- Pain with intercourse
- Incontinence or leaking urine
- Constipation
- Pelvic organ prolapse
- Scar tissue pain
- Low libido
- Depression or mood changes
See your doctor if you experience any of these problems after hysterectomy. An exam can be performed to evaluate and treat these concerns.
Does hysterectomy shorten lifespan?
No, research shows that removing the uterus and ovaries does not negatively impact longevity. In fact, a hysterectomy performed for appropriate reasons can improve quality of life. However, ovary removal before menopause may have impacts from the sudden loss of hormones that should be addressed.
Do you go through menopause after hysterectomy?
You will go through menopause after a hysterectomy if your ovaries are also removed. This causes immediate surgical menopause. If your ovaries remain, you will continue having normal hormonal function until reaching natural menopause at the average age of 51.
How often should you see gynecologist after hysterectomy?
Even without periods or pap smears, it is recommended to have an annual well-woman visit after hysterectomy. Your gynecologist will oversee your breast exams, mammograms, hormone therapy, bone health, sexual health, and cancer screening. See them more often if you have any symptoms or health issues.
The Bottom Line
While pelvic exams are generally not necessary after hysterectomy in asymptomatic women, continue seeing your gynecologist annually for overall health maintenance screenings, preventive care, and to address any concerns that arise after surgery. Be sure to follow up on any symptoms promptly as exams can be done if indicated.