For anyone who may not be familiar, I.E. most males (not including OBGYNs), a pelvic examination on a woman is when a physician inspects a female’s genitalia urethra, vaginal, and anal region; a speculum exam of the vagina and cervix; and bimanual examination of the uterus, cervix, ovaries, and the fallopian tubes.”
Recently, the American College of Physicians (ACP) has now issued a brand new guideline that actually recommends against performing this previously standard exams on normal women on their regular gynecologist visits. Docs Debate: Are Female Pelvic Exams Even Necessary?
In Opposition of the Pelvic Exam
The ACP now recommends against performing pelvic exams on women who are not pregnant or not suffering from any symptoms. The ACP ruled that asymptomatic women should not waste the precious time at in visits with vaginal exams because they are no benefit to patients. They found no evidence that these examiations could detect ovarian cancer, vaginosis, pelvic inflammatory disease, or other ailments. Additionally, they do not seem to show whether a woman has ovarian cancer. Therefore, the exam is not needed. Sometimes, pelvic exams are used for detecting STIs like chlamydia and gonorrhea. But, these can easily be found just testing using swaps of urine samples. However, pap smears will continue to be conducted.
The pelvic exam is not precise; it depends on the skill of the physician and cooperation of the patient.
According to the ACA: “With the available evidence, we conclude that screening pelvic examination exposes women to unnecessary and avoidable harms with no benefit (reduced mortality or morbidity rates). In addition, these examinations add unnecessary costs to the health care system ($2.6 billion in the United States). These costs may be amplified by expenses incurred by additional follow-up tests, including follow-up tests as a result of false-positive screening results; increased medical visits; and costs of keeping or obtaining health insurance.”
In Defense of the Pelvic Exam
Some feel that there are serious implications for patients and physicians that come along with the ACP’s new guideline. Some are saying that despite many saying they are feeling that there are no benefits for pelvic exams, that actually, it just means they found little evidence of benefits. Some physicians, like Barbara S. Levy MD (who is VP of American College of Obstetricians and Gynecologists (ACOG)) says, ” We continue to recommend that women receive annual pelvic exams, but we also clarify that the final decision should be made by a woman in consultation with her doctor, on the basis of her own needs and priorities. We do recognize the significant clinical value of the pelvic exam. I certainly hope that conversations between gynecologist and patient are open and include that value as well as an acknowledgement that the pelvic exam isn’t for everyone.”
Many feel that a lot of vaginal issues that are asymptomatic can be picked up during regular yearly pelvic exams. For example, small warts that a woman may not even be aware of may turn out to be a bigger issue that needs to be resolved. Without regularly checking, its possible that major problems continue to go undetected. For example, despite chlamydia tests being routine under the age of 25, a 28 year old may go to a visit and not know she is suffering from an STI without pelvic exams.
So physicians, what do you think? Is the pelvic exam a waste of time and money…or is it a beneficial procedure for women?