Vitality

Women's Health: Physicians, Gynecologists Disagree On When Women Should Get A Pelvic Exam

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Physicians and gynecologists agree on some aspects of routine pelvic exams, but not on how often women should get them. Pixabay

Whether or not women need routine pelvic examinations depends on who they ask, finds a new study published in the Annals of Internal Medicine.

"Routine pelvic [exams] have been a part of regular preventive care for decades — 62.8 million were performed in the United States in 2010," the study authors cited. "Historically, this examination was done in conjunction with annual cervical cancer screening. However, since cervical cancer screening can now be performed at intervals of up to every five years, depending on the patient, whether women need to see their physician annually for a routine pelvic [exam] is being questioned."

The question largely plagues primary physicians and gynecologists. In July 2014, the American College of Physicians (ACP) published a review that suggested pelvic exams don’t benefit the average woman. But more than that, routine exams lead to overtreatment and unnecessary costs. The American College of Obstetrics and Gynecology (ACOG), on the other hand, maintained "the annual visit is a fundamental part of medical care and provides an opportunity to promote prevention practices," as well as other healthy habits.

Which is it?

Study authors spoke with Ms. C, a healthy 41-year-old woman who recently visited her primary care physician for a periodic health exam. When her physician told her that there were new guidelines for concerning her annual exam, Ms. C thought back on all the years she sat through uncomfortable, albeit brief visits that apparently, now, she didn’t need to. Perhaps because she’d come to rely on her tests to ensure she was in good health, she asked for proof.

"I respect the professionals, so if you can provide proof from whatever studies have been done, then I think I would be more comfortable," Ms. C said. "Otherwise, I am going to think, ‘Oh, insurance companies are trying to save money; that’s why they’re doing that to us."

So the authors brought Ms. C’s question to primary care physician Dr. Jennifer Potter and obstetrician/gynecologist Dr. Hope Ricciotti — and perhaps unsurprisingly both women upheld their respective institutions’opinions: the ACP does not recommend a pelvic exam, and the ACOG does.

Potter would not recommend Ms. C get a pelvic exam based on current scientific evidence, though Ricciotti said there was "no current evidence [that] supports annual pelvic exam for asymptomatic, average-risk women."

While both women agree that there are "potential harms of performing screening pelvic exams, including over-diagnosis and overtreatment, not to mention patient fear, anxiety, embarrassment, and pain," they disagree on "what the effects of stopping routine pelvic exams would be." To Potter, fewer exams means "providers could refocus their resources on communicating with patients more effectively and increasing receipt of evidence-based care." Yet, Dr. Ricciotti was concerned providers would instead "lose the opportunity to initiate conversations about sexual and reproductive health or urinary symptoms that might indirectly improve quality of life."

As for using pelvic exams to diagnose chlamydia and gonorrhea, Potter and Ricciotti agreed samples could be self-collected. But the two disagreed again about whether providers should perform [bimanual examinations] at the time of a Pap smear, which is how doctors screen for cervical cancer, and whether there is a continued role for routine annual pelvic exam.

The bottom line: More research is needed to determine the optimal method for addressing issues surrounding the pelvic exam, including the timing for sensitive conversations, the overall exam value, and whether routine exams improve a woman’s quality of life.

For now, women should speak with their health care provider to weight the pros and cons of routine exams, so the two can arrive at a conclusion that makes sense to them.

Source: Burns R, Potter J, Ricciotti H, Reynolds E. Screening Pelvic Examinations in Adult Women: Grand Rounds Discussions From the Beth Israel Deaconess Medical Center. Annals of Internal Medicine. 2015.

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