Guideline: Most healthy women can skip pelvic exam
A medical group says there is no evidence that such exams are useful, except to those who come to the doctor’s office with medical complaints or who are pregnant.
The New York Times
Doctors should stop performing routine pelvic exams, a key component of regular physicals for women, an influential medical group said Monday.
There is no evidence that such pelvic exams are useful and plenty to suggest the procedure provokes fear, anxiety and pain in many women, the American College of Physicians (ACP) said in a new practice guideline for doctors.
The college’s guideline was published in the Annals of Internal Medicine and was accompanied by an article reviewing the scientific evidence. 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.
Scientific evidence “just doesn’t support the benefit of having a pelvic exam every year,” said guideline co-author Dr. Linda Humphrey of the Portland Veterans Affairs Medical Center and Oregon Health & Science University.
“There will be women who are relieved, and there are women who really want to go in and talk with their doctor about it and will choose to continue this,” she added.
The guidelines aren’t binding to doctors — or insurers.
The new recommendation contradicts guidelines from the American College of Obstetricians and Gynecologists, which immediately reiterated its support for yearly pelvic exams.
Pelvic exams have long been considered part of a “well-woman visit,” and some 62 million were performed in the United States in 2010, the latest available data.
Here’s what put the test under the microscope: Pap smears that check for cervical cancer used to be done yearly but now are recommended only every three to five years. So if women weren’t going through that test every year, did they still need the pelvic exam that traditionally accompanied it?
During a pelvic exam, a doctor feels for abnormalities in the ovaries, uterus and other pelvic organs. But two years ago, scientists at the Centers for Disease Control and Prevention reported that the internal exams weren’t a good screening tool for ovarian cancer and shouldn’t be required before a woman was prescribed birth-control pills.
The ACP, specialists in internal medicine, took a broader look.
Pelvic exams are appropriate for women with symptoms such as vaginal discharge, abnormal bleeding, pain, urinary problems or sexual dysfunction, the ACP said. And women should get their Pap smears on schedule — but a Pap doesn’t require the extra step of a manual pelvic exam, it said.
For symptom-free women, years of medical studies show routine pelvic exams aren’t useful to screen for ovarian or other gynecologic cancers, they don’t reduce deaths, and there are other ways, such as urine tests, to detect such problems as sexually transmitted infections, the doctors’ group reported in the journal Annals of Internal Medicine.
Moreover, pelvic exams can cause harm — from unnecessary and expensive extra testing when the exam sparks a false alarm, to the anxiety, embarrassment and discomfort that many women report, especially survivors of sexual abuse, the guidelines said.
No one knows how many women postpone a doctor’s visit for fear of a pelvic exam, Humphrey said.
Gynecologists agree that pelvic exams are not good tools for screening for ovarian cancer, which is notoriously difficult to diagnose. But, they say, experienced physicians can use pelvic exams to find other problems, such as noncancerous fibroids, and to identify changes linked to urinary incontinence and sexual dysfunction.
“Not everything we do in life can be studied in a randomized trial powered to find a scientifically valid answer one way or another,” said Dr. Barbara Levy, vice president for health policy at the American College of Obstetricians and Gynecologists.
“I’m not sure there’s evidence to support most of what we do on physical exams,” Levy added. “Lack of evidence does not mean lack of value.”
Dr. Ranit Mishori, a family physician and associate professor at Georgetown University School of Medicine, said the new guideline “gets rid of an unnecessary practice” that takes up valuable time that could be put to better use.
“Many women will be happy to hear that, and I think also, frankly, many physicians will be happy to hear it. Many of us have stopped doing them for a long time,” said Mishori, who wasn’t involved with the recommendations.
— Information from The Associated Press is included.