After reviewing nearly 70 years of medical records and studies, the American College of Physicians has come to the evidence-based conclusion that annual pelvic exams in adult women who are not pregnant and who do not have symptoms of pelvic disorders are unnecessary. Barbara Mantel spoke with the co-author of the new guidelines recently published in the Annals of Internal Medicine:
“There just wasn’t evidence that [routine pelvic examination] was beneficial,” says Humphrey. The review found that pelvic exams rarely detected ovarian cancer or bacterial infection and did not reduce mortality. Yet they add $2.6 billion in “unnecessary costs to the health care system,” according to the journal article.
The review also found potential harms, although the evidence was weak. These harms include embarrassment, fear, anxiety, pain and discomfort. Those were “magnified in women who had a history of sexual trauma, post-traumatic stress disorder or in overweight women,” says Humphrey.
Other potential harms include women avoiding health care visits because they dislike the exam and doctors finding abnormalities that don’t matter but that may lead to additional and invasive testing.
Alexandra Sifferlin says support for the new guidelines is not unanimous:
The American Congress of Obstetricians and Gynecologists (ACOG), considered the authority on reproductive health, still recommends yearly pelvic exams for women 21 years and older, though in a 2012 committee opinion, ACOG acknowledged that the “limitations of the internal pelvic examination should be recognized.”
This new guideline does not alter the recommendation that women get a Pap smear screening for cervical cancer every 3-5 years, nor does it diminish the importance of annual “well-women checkups”, as ACOG calls them, where patients can discuss symptoms and the need for a pelvic exam:
“We continue to urge women to visit their health care providers for annual visits, which play a valuable role in patient care,” said John C. Jennings, MD, President of the College. “An annual well-woman visit can help physicians to promote healthy living and preventive care, to evaluate patients for risk factors for medical conditions, and to identify existing medical conditions, thereby opening the door for treatment. Annual well-woman visits are important for quality care of women and their continued health.”
Most of us in the prevention business would second that statement.