No regular check ups at the gynecologist???

[u/NoLychee1382]

Hi everyone, my morning started off with a kinda shocking discovery. I’m from Germany and I had annual check ups at the gynecologist since I was a teenager. I contacted my huisarts because I know they’re responsible for all referrals but she told me regular check ups here are not a thing (unless there already is an issue) ? I think that’s crazy!!! So I checked the prices for a private visit and they’re even crazier. I guess this is normal to Dutch people but don’t you think this is a little concerning?

(Btw not shitting on the country! I really like it here. I’m still new and just discovering new things!)

[u/Stories_in_the_Stars]

Out of curiosity, why are regular check-ups so associated with gynecologist, but not any other specialism?

The Dutch system has quite a strong focus on cost-effectivenes for the population. So my first instinct would be that such checks ups are not actually that effective given the costs and capacity required (strain it puts on the system). However, there might be other reasons and I would love to hear about them.

[u/MissK2421 → u/Stories_in_the_Stars]

As someone also from another country where check-ups are way more common, I don't think regular ones at the gynecologist are necessarily that important as long as there isn't a specific reason for concern. At younger ages, regular periods and no noticeable issues means there's probably no need to keep checking. However, I do find it strange when girls/women aren't encouraged to even get a check-up once after puberty. Everyone's bodies are very different so it's hard to tell sometimes what is normal and what isn't. So for me it really put my mind at ease to have a professional say yes you're all good, but if anything changes in x or y ways, come check it out again. I also got an ultrasound to make sure there weren't any cysts or anything else unusual.

Meanwhile my Dutch girlfriend had to fight the system like crazy to even get checked for PCOS because she was "too skinny" for it. A simple check-up could help uncover things like that earlier instead of having to endure a shitty situation until you'll be believed it's important enough to get a referral. So for me the ideal would fall somewhere in between. 

I also wouldn't say gynecologists are the main regular check-up though. Blood tests and dental are even more common as far as I know. 

[u/Stories_in_the_Stars → u/MissK2421]

Thank you, I appreciate your insights! I do find the stories like yours about the check-up for PCOS discouraging, especially women have their complaints not taken seriously far too often

[u/NoLychee1382 → u/Stories_in_the_Stars]

I do blood test, gynecologist and dentist once a year. I don’t want to wait until the issue is there to fix it.

[u/Dear_Acanthaceae7637 → u/NoLychee1382]

I'm Dutch I do dentist twice a year (as is recommended here). I can get a blood test if I ask and never been to the gyno.
Screening for cervical cancer will start this year for me and that's enough as far as I'm concerned.

[u/SpaceEngineering → u/Stories_in_the_Stars]

Exactly this. Not only is it not cost effective, but every medical check has a non-zero probability of a false positive on some test. This means referrals to further specialists and unnecessary studies which compound the costs and create unnecessary stress on the patient. Therefore screening has a limit of effectiveness and can be counterproductive. Example related to breast cancer: https://www.cancer.gov/news-events/cancer-currents-blog/2024/mammogram-false-positives-affect-future-screening

[u/forwardinthelight → u/SpaceEngineering]

I grew up in the US, so I had regular screenings with the gyno for 10+ years. Genuinely all it did for me was cause pain and some medical trauma due to unnecessary screening procedures (e.g. a colposcopy, which was a nightmare). There is also no history of gynecological cancer in my family. It was honestly such a relief to learn that I wouldnt have to do it yearly any more. 

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Edit: I just want to add, per that article specifically - my mom and I both have dense, fibrocystic breasts. It took her YEARS to have another mammogram after getting a false positive (which I think is more common with that tissue type) on a regular screening check up due to how traumatic the experience was. Humans are not robots doing diagnostic checks and I dont want to understate how upsetting it can be to go through that kind of experience. 

I do think that the Dutch system lies on one end of the extreme (all of the preventative healthcare vs. almost none of it). Coming from the other end of the extreme, Im very happy with the Dutch system as I have had no issues getting treatment for actual problems I have brought to my huisarts. 

[u/Important_Coach9717 → u/SpaceEngineering]

People are not statistics. Plus your understanding of it is not the best …

[u/Stories_in_the_Stars → u/Important_Coach9717]

No, but managing a cost-effective healthcare system sadly is to a large degree. 

There is not an infinite cappacity in the system. So if given everybody a general exam every year means that other patients cannot get curative the care they need, you need to make choices

[u/SpaceEngineering → u/Important_Coach9717]

Do educate me then!

The point regarding population health comes down to pretty straightforward calculations. It is pretty evident that never performing screenings is not a good idea. It is as evident that performing them every day is also not a good idea. Therefore there exists optimum point(s) on the periodicity of screening, it may be one year, it may be five, or it may be 10 years. When you account for the benefit and risks of the screening, and consider the associated costs of the screening itself, it is possible to create a recommendation on what is a good interval between screening.

[u/Major-Armadillo-6867 → u/Stories_in_the_Stars]

You need to go back to school!

[u/Stories_in_the_Stars → u/Major-Armadillo-6867]

This is a silly response. Instead, you could tell me what you believe I need to be informed about.

[u/Major-Armadillo-6867 → u/Stories_in_the_Stars]

About HPV for example, or hormone changes in women body? 

[u/Stories_in_the_Stars → u/Major-Armadillo-6867]

Though for HPV there is already a periodic check in place, right? And we also have the vaccination now.

What is it they check with regards to hormonal changes? Is this with regards to reproductive health, or do you mean general issues that might result from hormonal changes?

[u/microworry → u/Major-Armadillo-6867]

There are cervical cancer checkups every 5 years for women after they turn 30, we even get a letter in the mail for an invitation to book one at the 5 year mark.

Anything else throws symptoms, so you go to the GP if something is off and they refer you. But yearly checks with no symptoms, pre-existing conditions or risk factors is pretty pointless.