Why you should still see a gynecologist after age 65
U.S. Preventive Services Task Force (USPSTF) guidelines recommend against screening for cervical cancer in women older than 65 years who have had adequate prior screening and are not otherwise at high risk for cervical cancer. But, the advisory may be leading to many women mistakenly thinking that they no longer need to see a gynecologist.
The misperception is so widespread that gynecologist Richard Heywood, DO, FACOG, at Falmouth Women’s Health in Mashpee, regularly jokes with his patients, “I’m so much more than just a pap test.”
He points out that guidelines are not absolute rules in medicine, especially because they don’t take the individual into consideration.
“We have to consider every person as an individual and what their history is and what their risks are,” he said. “So, if someone has a history of cervical dysplasia or HPV or procedures on their cervix, they might be somebody who we want to continue to monitor because they could still have something that could turn into cancer.”
It's also important to know a patient’s personal history. For example, if a woman over the age of 65 loses her husband or gets divorced, she might be dating again for the first time in decades. Since women that age can’t get pregnant, many of them don’t think about using condoms. In today’s day and age, that can have consequences.
According to the American Medical Association, about 40 percent of seniors age 65 to 80 are sexually active, and sexually transmitted diseases in that population have more than doubled in the past decade. In those aged 65 and older, chlamydia cases have more than tripled between 2010 and 2023, gonorrhea cases increased sixfold, and syphilis cases increased nearly tenfold.
Other GYN Issues
Other gynecological problems that a gynecologist can help with include pelvic prolapse, painful sex and urinary incontinence. So many senior women keep these conditions to themselves because they don’t know that anything can be done to fix those problems, Dr. Heywood said. He regularly does surgery to fix urinary incontinence.
“Honestly it’s one of the most rewarding surgeries that I do,” he said. “The sad part is people don’t talk about it and women suffer in silence until they meet a gynecologist that actually does these things and talks about it. They don’t say anything. They never bring it up and they just suffer.”
Looking at a Woman’s Overall Health
The other reason women should see their gynecologist annually is that he or she looks at a woman’s overall health. They take your blood pressure and ask about symptoms of cardiovascular disease. They consider your mental health, your breast health, your gastrointestinal health and your vulvar health. For women who don’t have access to a primary care provider, a gynecologist may be the front line for some women.
Plus, Medicare doesn’t cover traditional physicals for people over the age of 65. They are eligible for a one-time “Welcome to Medicare” visit and then annual wellness visits that cover things like prescriptions, ordering labs, and screening for depression and substance abuse, but don’t cover an actual physical exam.
“The gynecologist might be the only doctor that actually looks at you and examines your body,” Dr. Heywood said. “It’s not unusual for me to find an early vulvar cancer or a lesion or a prolapse that’s bothering someone and, until I see it and bring it up, they say I never complained about that because I didn’t know there was anything you could do about that. They were just suffering with it.”
