Most gynecologists suggest that their patients go through regular pelvic exams. But some experts are saying this process is not actually necessary. Do they force these exams on patients too soon and too often? Are you incurring unnecessary financial expenses?

The New York Times reports on the apparent lack of need for pelvic exams. Influential medical groups have conducted research showing that women do not need to have routine pelvic exams as their physicians often suggest them to.

The researchers say that the exams are futile and not worth the anxiety and pain that women face as a result of them. Their recent report was published in The Annals of Internal Medicine. Dr. Adamson who used to be the president of the American College of Physicians commented on the report saying, “The pelvic exam has become a yearly ritual, but I think it’s something women do not necessarily look forward to. A lot of women dread it.”

So what does a pelvic exam entail?

The Times explains, “A pelvic exam consists of three elements: inspection of the external genitalia, examination of the vagina and cervix, and the so-called bimanual examination, in which the physician inserts a gloved finger into a woman’s vagina and, with the other hand, presses down on her abdomen to check the shape and size of her uterus, ovaries and fallopian tubes. The exam takes up time during an annual physical and often requires the presence of a chaperone in the room, which raises costs.”

Why are experts calling them futile? Don’t they seem like they would be effective and necessary? “The American College of Physicians reviewed studies of the procedure and concluded that pelvic exams are not accurate diagnostic screening tests for ovarian cancer. A dozen studies have suggested that many women experience pain or discomfort during the exams, and they may be particularly traumatic for women who have been sexually assaulted.

The reviewers said that they could not even locate studies that had assessed whether routine pelvic exams of asymptomatic women could reduce death or disease from ovarian and other cancers, or benefit women with common benign conditions such as pelvic inflammatory disease, fibroids or warts,” according to The Times.

How long has this been going on?

Pelvic exams have been around for decades. And until about ten years ago they were also used to test women for STDs. But due to the discomfort that they cause, doctors started using urine samples to test for STDs and STIs. The Times says, “In recent years some experts have suggested that pelvic exams are so discomforting that they may deter women from going to the doctor altogether. Gynecologists agree that pelvic exams are not good tools for screening for ovarian cancer, which is notoriously difficult to diagnose.”

Why the sudden change in treatment advice?

The Times reports, “The new guideline comes as more routine procedures are critically evaluated in light of scientific studies, part of a move toward evidence-based medicine. Over the past few years, several new sets of guidelines have urged scaling back screening procedures for women in particular.”

Reuters also commented on the new report.

Reuters explains the benefits of the study and also delves into the fact that the report applies to women who are generally healthy, not women who have health issues or pregnant women. The new recommendation (made by the American College of Physicians) also does not apply to pap smears.

[Comment...I wonder how many of these recommendations are based on the need to focus on costs rather than on health benefits.]

Dr. Humphrey, who co-authored the study, told Reuters, “In the absence of demonstrated benefit and in the presence of demonstrated harm, the equation just goes on the side of not doing something. The group was prompted to look at pelvic exams because they are closely linked to cervical cancer screenings. Recently other medical organizations and task forces have suggested screening certain women for cervical cancer every few years instead of annually, but they did not address pelvic exams. The thinking behind it was we need to understand the data on this part of the exam now that the cervical cancer guidelines have changed.”

How many pelvic exams are usually done in the United States every year? Are they really that prevalent? Well, statistics show that around sixty-three million pelvic exams were done in the U.S. in 2010.

Has there been any other research showing that pelvic exams are not necessary? Reuters reports, “A review of past studies compiled for the ACP and published in the same journal did not find evidence to support routine pelvic exams in asymptomatic women.”

What do other American health agencies say about pelvic exams? Do they endorse them or are they against them?

The American College of Obstetricians and Gynecologists commented on this study in a statement saying, “ACOG recommends the decision about whether to perform a pelvic examination be a shared decision between health care provider and patient, based on her own individual needs, requests and preferences. Pelvic examinations also allow gynecologists to explain a patient’s anatomy, reassure her of normalcy and answer her specific questions, thus establishing open communication between patient and physician.”

Other expert gynecologists in the field are saying that before their colleagues force or even suggest that their patients pay for pelvic exams and more importantly go through the pain of them they should prove to them that they have some kind of beneficial effect.

“Drs. Sawaya and Jacoby from the University of California, San Francisco write that ACP’s announcement should prompt those who recommend routine pelvic exams to demonstrate the screening does more good than harm. Remember there are two sides to any screening claim. They have to make a claim that the net benefit is worth it,” according to Reuters.

CBS news endorses the study as well.

CBS says the report is comprehensive and was based off of information from exams conducted from 1946 to 2014. So if pelvic exams do not need to be a regular thing then who should get them and how often?

“The U.S. Task Force does not currently offer a set of guidelines specifically for pelvic examinations. The authors of the new ACP guidelines assert that a full pelvic exam should be reserved for women experiencing symptoms such as vaginal discharge, abnormal bleeding, pain, urinary problems or sexual dysfunction. Additionally they argue that routine pelvic exams in otherwise healthy patients may be an unnecessary expense to the U.S. health care system, especially as the Affordable Care Act seeks to expand access to preventive care by requiring insurance companies cover annual wellness visits for all women,” according to CBS.  

In spite of these findings there are still many physicians who say they are going to regularly suggest and conduct pelvic exams. Dr. Shirazian, a gynecologist at Mount Sinai Hospital in New York City, told CBS News she will “Continue to provide her patients with full pelvic exams despite these new recommendations. It does raise the question, if we are not going to be offering any screening test or exams during the annual visit then are we going to do annual visits? For me, I'm a gynecologist so I've examined thousands of women. I've picked up very early findings in my patients, early fibroids, early cysts. Some of the patients were asymptomatic, some of the patients did have symptoms but didn't realize that those symptoms were linked with their uterus or ovaries.”

Some physician experts in the field said that it is not only the added cost that becomes a deterrent. It is the pain, embarrassment and fear that women who go through pelvic exams face that they want to prevent if it is not necessary. Surveys show that some women have so much anxiety about pelvic exams that it deters them from going to the hospital altogether.

Gerry Oginski
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