Are the regular routing pelvic exama actually necessary? The country’s influential doctors’ group insists no, arguing that there is no evidence that the exams are useful.
Doctors of the American College of Physician claim that the unpleasant for many women procedure may cause fear, anxiety and even pain.
The college’s guideline was published in the Annals of Internal Medicine. The recommendation applies only to routine checkups for healthy women, not to women who visit the doctor’s office with medical complaints or who are pregnant.
“The pelvic exam has become a yearly ritual, but I think it’s something women don’t necessarily look forward to,” said Dr. Sandra Adamson Fryhofer, an internist in Atlanta who is a former president of the college. “A lot of women dread it.”
“It is a fairly straightforward, simple guideline,” says Dr. Linda Humphrey, co-author of the guidelines, a professor of medicine, public health and preventive medicine at Oregon Health & Science University in Portland. According to her, the results of the study are based on a “very strong” review of nearly 70 years of medical studies.
“There just wasn’t evidence that [routine pelvic examination] was beneficial,” the expert added. The study unveiled that pelvic exams rarely detected ovarian cancer or bacterial infection and did not reduce mortality. Yet they add $2.6 billion in “unnecessary costs to the health care system,” the journal article reads.
The review also found potential harms, although the evidence was weak. The list of harm includes embarrassment, fear, anxiety, pain and discomfort. Those were “magnified in women who had a history of sexual trauma, post-traumatic stress disorder or in overweight women,” says Humphrey.
Which is more, there’re also cases when women avoid routing visits because they dislike the exam and doctors finding abnormalities that don’t matter but that may lead to additional and invasive testing.
The American College of Obstetricians and Gynecologists admits that there is no evidence proving that routine pelvic exams can save lives or do a good job of detecting ovarian cancer or infection.
However, this procedure do have value. Its guideline, published in 2012, continues to recommend exams and encourages women to discuss whether to have one with their health care provider. If a woman doesn’t want the exam, she should still have an annual check-up.
“It is the experience of the members of our practice committee and our executive board and those of us who created this guideline that, indeed, women coming to see us who are ‘asymptomatic’ often have issues that they want to discuss but don’t raise them with us initially,” says Dr. Barbara Levy, the group’s vice president for health policy.
“The pelvic examination creates an opportunity for us to raise those issues with a patient if we see something on the exam,” she added.
For example, a woman might be too embarrassed to talk about incontinence, but “the position of the urethra” — the tube from the bladder to the outside — “relative to other tissues can raise a red flag for a clinician that indicates, ‘I should ask her about whether she is leaking urine,’” says Levy.
Both Levy and Humphrey agree that women may come away from the different guidelines somewhat confused. “But if it starts a conversation between a woman and her physician or provider, I think that is terrific and as it should be,” says Levy.