Are Routine Pelvic Exams a Thing of the Past?


"Pelvic examination findings do not affect the decision to prescribe or withhold systemic hormonal contraception; a pelvic examination is not needed to initiate these contraceptives. Clinical trial data ... show [that bimanual exams] do not lead to earlier detection of ovarian cancer," the authors write. "No evidence identifies benefits of a pelvic examination in the early diagnosis of other conditions in the asymptomatic."

What's more, while pap smears remain an integral part of early detection of cervical cancer in women, recent changes in the ACOG guidelines now only recommend that they be given every two years to women in their 20s and every three years to women 30 and older, providing that the woman has no previous history of abnormal pap smears and no symptoms.

"These arguments are all facts, based on recommendations as well as studies that have been done," Shepherd says.

So why do most women continue to receive pelvic exams and pap smears annually? Gynecologists say that much of it just has to do with inertia: many of the guidelines quoted above are relatively new and it will take time for both women and their doctors to adjust to the idea that these tests are not needed every year.

For decades that was the standard of practice and thus many women have become used to this being a necessary part of their own preventive care.

"I have a hard time telling my patients [over 30], 'I'll see you in three years.' They tell me they want to come in for the pap smear every year and I'm not going to fight it. But [given the new guidelines], eventually insurance companies will stop paying for it," says Dr. Jacques Moritz, director of gynecology at St. Luke's-Roosevelt Hospital in New York.

"We have indoctrinated women with guilt and other things to go to the GYN every year and what has that done? It's brought the rate of cervical cancer way down, but that makes women feel bad now if they don't go every year and get a pap smear," he adds.

Paps and Pelvics and Prevention, Oh My!

Of course, all of this hinges on the patient being asymptomatic, something that some gynecologists don't think can always be deemed by patient self-report.

"For example, women assume 'discharge' is normal ... other women assume that incontinence is 'normal'," says Dr. Joanna Cain, chair of Brown University's Department of Obstetrics and Gynecology. "The author presumes that these "symptoms" will be picked up and an exam done -- but that isn't really the case."

But just because pelvics and pap smears are not needed every year does not mean that women should see their gynecologist annually and that women shouldn't be quizzed concerning possible symptoms or overall health, Shepherd says.

"The focus should be not on the fact that paps aren't needed but that annual visits are needed, in which women discuss preventative measures go for mammograms and have other screening -- these visits just don't necessarily necessitate a pelvic."

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