Annual Pelvic Exams Not Necessary For All Women

Women have always been encouraged to receive a pelvic exam during their annual visit to the gynecologist. However, the American College of Physicians (ACP) is advising that these routine exams are not necessary for symptomless women and is causing more harm in these healthy women.

In a new evidence-based guideline, “Screening Pelvic Examination in Adult Women,” published in Annals of Internal Medicine, the ACP states that only women with symptoms should be having annual pelvic exams. In 2010, 62 million American women had a pelvic exam as part of their routine womanly health evaluation.

“This recommendation will be controversial,” obstetrician-gynecologist Dr. George Sawaya wrote in an accompanying editorial. “Pelvic exams have long been considered a fundamental component of the well-woman visit.”

Pelvic exams are used as a screening for abnormalities in the ovaries, uterus, and other pelvic organs. However, the Centers for Disease Control and Prevention (CDC) previously reported that these exams were not an effective screening method. Pap smears that do check for cervical cancer has also seen a change in recommendation, now to be done every three to five years instead of annually.  This led medical professionals to wonder whether pelvic exams were done out of habit rather than necessity.

“Routine pelvic examination has not been shown to benefit asymptomatic, average risk, non-pregnant women. It rarely detects important disease and does not reduce mortality, and is associated with discomfort for many women, false positive and negative examinations, and extra cost,” co-author of the guideline and member of the ACP’s Clinical Practice Guidelines Committee, Dr. Linda Humphrey said in a press statement.

During the exam, the gynecologist checks the vulva, uterus, cervix, fallopian tubes, ovaries, balder, and rectum during a pelvic exam. Pelvic exams can cause a little discomfort, but are not painful. The gynecologist will ask you to lie on your back and put your feet in the stirrups. They will press down on your lower stomach to feel organs from the outside and insert a speculum into your vagina so that the cervix can be seen. The gynecologist then may perform a Pap smear. Pap smear testing consists of the gynecologist using a Q-tip-like tool to scrape cervical cells for cancer and disease testing. After removing the speculum, the gynecologist will then check the size and shape of your organs internally with two fingers. The entire exam takes about 10 minutes.

According to the new ACP guidelines, only women with symptoms should still have a yearly pelvic exam. These symptoms include: vaginal discharge, abnormal bleeding, urinary problems, pain, or sexual dysfunction. For symptom-free women, the exam does not reduce death related to ovarian and other gynecologic cancers. The exams could also cause false-positives, which spark a wide range of emotions in women. Not to mention that unnecessary testing is only adding to the increased amount of money this country spends on health care.

The guidelines still recommend that women receive their Pap smear screenings. 72.8 % of white women, 77.9 % of black, 68 % of Asian, and 73.6 % of Hispanic or Latina women in the U.S. ages 18 and older had a Pap smear test in 2010. Pap smear testing is the best way to identify abnormal, precancerous cell growth in the cervix.

Women who are pregnant should also receive their routine pelvic examinations.

While the ACP is urging doctors to stop using the exams as a screening tool, some OB-GYNs believe that these guidelines can compromise women’s healthcare. The guidelines do not include women who have a family history risk of cervical cancer. Many women may have no symptoms and then a mass can be found. The American Congress of Obstetricians and Gynecologists (ACOG) still recommends annual pelvic exams for women who are 21 and older.

According to the CDC, cervical cancer is the leading cause of cancer death for women in the U.S. In 2010, 11,818 women were diagnosed with cervical cancer, whereas 3,939 cases were terminal.