Healthy Women & Pelvic Exams
Each year, millions of women in the U.S. head to their gynecologist for an annual check-up. While it may not be the most pleasant experience in the world, most consider the prodding and mild discomfort of a routine pelvic exam to be an essential part of preventive health care. But now the American College of Physicians (ACP) is challenging the need for this practice, A new set of guidelines that recommends against annual pelvic exams for healthy, non-pregnant women.
The new guidelines only apply to the pelvic exam, and only in healthy women. The panel urged women to keep getting checked for cervical cancer. Also, the experts emphasized that pelvic exams remain a necessary part of the evaluation in any woman with symptoms that could be related to a problem with the vagina, cervix, uterus, Fallopian tubes, or ovaries. It’s also important to note that the American College of Obstetricians and Gynecologists still recommends a yearly pelvic exam for women, even though it acknowledges that the evidence does not support or refute its value.
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.The recommendations aren’t binding to doctors – or insurers. Indeed, a different doctors’ group, the American College of Obstetricians and Gynecologists, still recommends yearly pelvic exams, even as it acknowledges a lack of evidence supporting, or refuting, them. 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. Some women will feel that their annual check-up is not complete without a pelvic exam, just as some men do about the rectal exam. And some doctors will find it difficult to stop doing these exams, since they learned these rituals in medical school and were told they were beneficial.
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. 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.
Despite its continued recommendation for annual pelvic exams, the American College of Obstetricians and Gynecologists said in 2012 that patients should decide together with their providers whether to have them.Sometimes that exam lets the doctor spot, say, problems around the uterus that might lead to questions about incontinence that the supposedly asymptomatic patient was too embarrassed to bring up. Clinicians who continue to offer the examination should at least be cognizant of the uncertainty of benefit and the potential to cause harm through a positive test result and the cascade of events that follow. Annual exams are meant to be visits which are also opportunities for women to maintain a good patient-physician relationship.