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Women 65 and over typically don't need routine pelvic exams

Dear Doctor: I'm a 76-year-old woman who had a complete hysterectomy when I was 50. My daughters insist that I should still be seeing a gynecologist for cervical cancer screenings, including pelvic exams. Is this really necessary? I already see my family physician every six months for a checkup and blood work.

Dear Reader: Your daughters' confidence in this screening is understandable. Pap smears are an important part of primary care medicine, proven to decrease the rates of cervical cancer and related deaths. Years ago, physicians recommended annual Pap smears for every woman over the age of 21. Now, with the knowledge that cervical cancer is directly linked to HPV infection, doctors understand that screening intervals for Pap smears no longer have to be yearly. The U.S. Preventive Services Task Force now recommends Pap smears every three years for women ages 21 to 30, and both Pap smears and HPV tests every five years for those ages 30 to 65. These recommendations include shorter intervals if the Pap smear shows abnormalities or if the HPV test is positive.

Women who haven't had an abnormal Pap smear and whose HPV tests have been negative have a very low risk of developing cervical cancer after the age of 65. One reason for this is the low likelihood of acquiring a new HPV infection past that age. Many doctors -- including myself -- don't normally recommend Pap smears for women over age 65.

Women who have had a total hysterectomy, in which the cervix is removed, are even less likely to need a Pap smear. Some hysterectomies remove the uterus and leave the cervix, but that would have been highly unlikely 26 years ago. For that reason, I'm assuming that your cervix was removed. If so, you cannot develop a new cervical cancer. If your cervix showed cervical cancer before it was removed, then a Pap smear is reasonable to assess whether the cancer may have returned.

True, other cancers can sometimes be found on a pelvic exam, such as ovarian cancers, uterine and vaginal cancers, but not very reliably -- meaning pelvic exams yield little benefit. For instance, although the only good screening test for vaginal cancer is a visual exam of the area, because the incidence is low (1 in 100,000 women), the yield for screening is also low. Ovarian cancer is much more common, but has no good screening tests. A pelvic exam can sometimes detect an ovarian cancer, but not easily; the tumors are generally small and the ovaries' location makes finding them difficult. As for uterine cancers, they're typically found when a woman notes abnormal bleeding from the uterus.

When I started medical school, many physicians did yearly Pap smears and pelvic exams on women over age 65. As the science became clearer, the medical community has altered its thinking. Although some physicians still recommend yearly Pap smears and pelvic exams regardless of a woman's age, the practice is becoming increasingly less prevalent.

Unless you have one of the signs of cancer in the pelvic region, such as vaginal/uterine bleeding, abdominal bloating or pain or vaginal pain, you're correct: there's little use for a routine pelvic exam.

Dating with autism

Dear Annie: I am a 36-year-old man living with my father. I also have autism, and because of this, I have had difficulty in dating women.

For a few years, I was on the dating website called I Love Your Accent (I had been on 10 other sites prior to that), which matches American and British singles, but nothing happened.

Then, last fall, I downloaded the app UK Social and became friends with a British girl from Birmingham. As it turned out, she was not trustworthy. She asked for money, and I had to end the conversation. My mother got upset and intervened.

Now I am starting a relationship with a girl around here named "Erin." There is a problem: She is somewhat nerdy and has the same condition I have. What should I do? Should I wait for the ideal girl to come around or stay with Erin and see what happens? -- Ethan in Hanover

Dear Ethan in Hanover: There's no such thing as an ideal girl. There is only a girl who is ideal -- or close enough to ideal -- for you. Don't dismiss Erin simply because she's "nerdy." If she's a nerd, that just means she has interests she's passionate about. Strong interests make people interesting. And if you both have autism spectrum disorders, you might find that you understand each other in a unique way. I say give it a try. You don't need to make any major decisions right away, but go on some more dates with Erin and see how you two get along. Good luck.

Dear Annie: Recently, you printed a letter from "Betty," who wrote about the death of a friend and how she was treated by family.

I loved her suggestions regarding caring for the dying. Back in 2013, my 92-year-old mother went downhill in a hurry. We called in the angels from hospice, and they talked us into using a hospital bed in a second bedroom. Even though I wished there were some way for her to continue sleeping with my dad, she became too fragile to move.

The day we were warned that her struggle was not to last very long, my dad and I took up a vigil. Most of the time, we were both with her, praying the rosary and talking softly to her, reminiscing about happy times. Shortly after midnight, I needed to take a break and went into the living room with the nurse. Not five minutes later, I heard my dad's chair creak, and by the time I got to the doorway, he was kissing her goodbye. He passed me without a word and went to bed. I sincerely believe she was waiting until she could be alone with him before letting go.

When my dad and I had a chance to talk about it much later, he agreed that he was happy to have had alone time with her. I thought he needed my presence to bring him comfort. I think I should have given him more alone time with her. They had been married for over 73 years, and except for during World War II, they had very rarely spent bedtime away from each other. -- Fortunate Daughter

Dear Fortunate Daughter: I believe your letter will touch many hearts, as it certainly touched mine. Thank you for writing.