Routine pelvic exams, the standard practice of poking and prodding below the waist for signs of disease, provide little benefit for healthy women who aren’t pregnant and should be skipped in this group, according to new recommendations from the American College of Physicians.
The exam rarely detects diseases like cancer, doesn’t reduce death rates and is associated with discomfort and false positives, according to the guidelines published in the Annals of Internal Medicine. Pelvic exams are appropriate for pregnant women or women who have symptoms such as abnormal bleeding, pain, sexual dysfunction and vaginal discharge.
A pelvic exam consists of a visual examination as well as an internal inspection of the uterus, ovaries and bladder. More than 60 million of these exams are performed in the U.S. each year, the authors said. The exams offer no benefit for healthy women, expose them to unnecessary harms and add costs to the health-care system, the researchers said.
“This guideline isn’t saying don’t do a pelvic exam in people with symptoms. What this is saying is we don’t need to do pelvic exams in women without symptoms,” Linda Humphrey, one of the authors of the guidelines and a professor of medicine at Oregon Health & Science University in Portland, said in a telephone interview. “It’s a relatively crude exam. It’s like feeling the lungs for lung cancer. We have so many better modalities for doing these things.”
The new guidelines don’t apply to the pap smear, a test that used to be recommended annually to check for cervical cancer. The U.S. Preventive Services Task Force, an independent medical advisory group to the government, along with three cancer groups recommended in 2012 that women ages 21 to 65 receive a pap smear every three years rather than every year. Women ages 30 to 65 who want to extend the interval can get the pap smear and testing for human papillomavirus every five years. No testing is needed for women over the age of 65 who have had adequate prior screening.
The recommendations were based on a review of 52 studies and guidelines from 1946 through January 2014 done by the Minneapolis Veterans Affairs Health Care System. The review was also published in the Annals of Internal Medicine.
The researchers found no studies that assessed the morbidity or mortality benefits of routine pelvic exam for the detection of ovarian, uterine, bladder or vaginal cancer or pelvic inflammatory disease, fibroids or any other gynecologic condition in average-risk women. The researchers found no studies that examined the hypothesis that the indirect benefit of a pelvic exam is that it prompts women to see their doctor for preventive care.
The review showed the screening exam led to unnecessary surgery, pain and discomfort, fear, embarrassment and anxiety.
George Sawaya, who wrote an accompanying editorial, said doctors have done pelvic exams for decades and the test has become more of a ritual than an evidence-based practice.
“We always need to reconsider what we’re doing that’s standard practice to make sure it has value,” Sawaya, a professor of obstetrics and gynecology and reproductive services at the University of California at San Francisco, said in a telephone interview. “This will prompt some really important, thoughtful conversations around this exam.”