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The annual pelvic exam has long been a routine part of women’s health care but new guidelines say there’s no good reason for it. The recommendations laid out by the American College of Physicians (ACP), advice against pelvic exams for women who aren’t pregnant and have no symptoms of a potential problem.
“There’s no good evidence the screening exams benefit women,” the ACP said.” I think a lot of women will be relieved by this, especially since it’s based on scientific evidence,” said Dr. Linda Humphrey, a member of the ACP’s Clinical Practice Guidelines Committee, which devised the new advice after reviewing 32 studies on the benefits and harms of routine pelvic exams. Humphrey stressed that the new guidelines apply only to pelvic exams and that women should continue to have cervical cancer screenings.
“For healthy women with no symptoms, the procedure’s harms outweigh its benefits,” the ACP said. The group’s review found that the ability of pelvic exams to catch ovarian cancer and other treatable diseases such as certain infections is low. What’s more, some surveys have found that about a third of women say they have experienced pain discomfort, fear, embarrassment or anxiety from the procedure.
Across eight surveys, anywhere from 11 percent to 60 percent of women called pelvic exams painful or uncomfortable. And in seven studies, 10 percent to 80 percent of women cited fear, anxiety or embarrassment.
During a pelvic exam, a woman places her feet in stirrups and the doctor inserts an instrument called a speculum in order to view the vagina and cervix. Next, the doctor places two fingers in the patient’s vagina and the other hand on her abdomen to feel for problems in the ovaries, uterus and bladder.
The new recommendations do not apply to Pap smear screening, which involves collecting cells from the cervix to screen for cervical cancer and is recommended every three to five years depending on a woman’s age.
The recommendations are likely to be controversial. The American College of Obstetricians and Gynecologists (ACOG), a group with more than 58,000 members, recommends yearly pelvic exams for women ages 21 years and older but acknowledges that no current scientific evidence supports or refutes an annual pelvic exam for an asymptomatic, low-risk patient. Instead, the recommendation is based on doctor’s experience treating their patients, ACOG said.
Ultimately, the decision about whether to perform a pelvic exam should be a shared decision between doctor and patient, ACOG said.
“The reasoning behind why clinicians are doing it has never been very clear,” said Dr. George Sawaya, a professor of obstetrics, gynecology and reproductive sciences at the University of California, San Francisco.
Instead, the pelvic exam is more like a “ritual” than an evidence based practice, said Sawaya, who co-wrote an editorial published with the new guidelines in the July 1 issue of the Annals of Internal Medicine.
The reason women have the exam yearly is because it has been traditionally coupled with Pap testing for cervical cancer, Sawaya noted. However, experts no longer recommend annual Pap tests and instead say women at average risk of cervical cancer can have them every three years, starting at age 21.