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Guideline: Most healthy women can skip pelvic exam

Female doctor discussing with a patient

BY LAURAN NEERGAARD
‚ÄčAP MEDICAL WRITER

WASHINGTON (AP) -- No more dreaded pelvic exam? New guidelines say most healthy women can skip the yearly ritual.

Routine pelvic exams don't benefit women who have no symptoms of disease and who aren't pregnant, and they can cause harm, the American College of Physicians said Monday as it recommended that doctors quit using them as a screening tool.

It's part of a growing movement to evaluate whether many longtime medical practices are done more out of habit than necessity, and the guideline is sure to be controversial.

Scientific evidence "just doesn't support the benefit of having a pelvic exam every year," said guideline coauthor Dr. Linda Humphrey of the Portland Veterans Affairs Medical Center and Oregon Health & Science University.

"There will be women who are relieved, and there are women who really want to go in and talk with their doctor about it and will choose to continue this," she added.

The recommendations aren't binding to doctors -- or insurers.

Indeed, a different doctors' group, the American College of Obstetricians and Gynecologists, still recommends yearly pelvic exams, even as it acknowledges a lack of evidence supporting, or refuting, them.

Pelvic exams have long been considered part of a "well-woman visit," and some 62 million were performed in the United States in 2010, the latest available data.

Here's what put the test under the microscope: Pap smears that check for cervical cancer used to be done yearly but now are recommended only every three to five years. So if women weren't going through that test every year, did they still need the pelvic exam that traditionally accompanied it?

During a pelvic exam, a doctor feels for abnormalities in the ovaries, uterus and other pelvic organs. But two years ago, scientists at the Centers for Disease Control and Prevention reported that the internal exams weren't a good screening tool for ovarian cancer and shouldn't be required before a woman was prescribed birth control pills.

The American College of Physicians, specialists in internal medicine, took a broader look.

Pelvic exams are appropriate for women with symptoms such as vaginal discharge, abnormal bleeding, pain, urinary problems or sexual dysfunction, the ACP said. And women should get their Pap smears on schedule - but a Pap doesn't require the extra step of a manual pelvic exam, it said.

For symptom-free women, years of medical studies show routine pelvic exams aren't useful to screen for ovarian or other gynecologic cancers, they don't reduce deaths, and there are other ways, such as urine tests, to detect such problems as sexually transmitted infections, the doctors' group reported in the journal Annals of Internal Medicine.

Moreover, pelvic exams can cause harm - from unnecessary and expensive extra testing when the exam sparks a false alarm, to the anxiety, embarrassment and discomfort that many women report, especially survivors of sexual abuse, the guidelines said.

No one knows how many women postpone a doctor's visit for fear of a pelvic exam, Humphrey said.

Dr. Ranit Mishori, a family physician and associate professor at Georgetown University School of Medicine, said the new guideline "gets rid of an unnecessary practice" that takes up valuable time that could be put to better use.

"Many women will be happy to hear that, and I think also, frankly, many physicians will be happy to hear it. Many of us have stopped doing them for a long time," said Mishori, who wasn't involved with the recommendations.

Despite its continued recommendation for annual pelvic exams, the American College of Obstetricians and Gynecologists said in 2012 that patients should decide together with their providers whether to have them.

Sometimes that exam lets the doctor spot, say, problems around the uterus that might lead to questions about incontinence that the supposedly asymptomatic patient was too embarrassed to bring up, said ACOG vice president Dr. Barbara Levy.

"Women have an expectation that they're going to have an exam" if they choose a gynecologist, Levy said.

An editorial published alongside the guidelines Monday cautioned that pelvic exams also look for noncancerous uterine and ovarian growths, and the scientific review didn't address whether that's beneficial.

Still, editorial coauthors Drs. George Sawaya and Vanessa Jacoby of the University of California, San Francisco, said that whether the new guideline changes doctors' practice or not, it could lead to better evaluation of what "has become more of a ritual than an evidence-based practice."

"Clinicians who continue to offer the examination should at least be cognizant of the uncertainty of benefit and the potential to cause harm through a positive test result and the cascade of events that follow," they wrote.

© 2014 THE ASSOCIATED PRESS. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED. Learn more about our PRIVACY POLICY and TERMS OF USE.

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ohioh111b111y July 01 2014 at 8:40 AM

Insurance companies want to cut costs huh? The most expensive thing for Women with insurance is the yearly pelvic and follow up problems. Ah, women are disposable. Who cares if their cancers are caught too late? next!

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3 replies
Cheryl July 01 2014 at 10:32 AM

That is total and complete bull! Womens health is being slashed year after year because some moron thinks the exams are unneccessary..ie mammograms, pap smears..and now you want to take away the pelvic exam? OMG..Being in health care for 35 years, I have seen both pelvic and mammos save lives..no woman enjoys these exams but those with a little sense knows the importance of it...how dare a group of morons try to help decrease the female population because they have issues with female exams....HOT IN VIRGINIA

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4 replies
Nancy July 01 2014 at 9:41 AM

Using the word 'dreaded' is not helpful. Getting an annual exam is. The 'harm' mentioned is only if the physician doing the exam is not professional. There isn't a thing sexual about it when done correctly. And it is probably the only thing that gets many women in regularly for health checks.

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1 reply
Lisa Nancy July 01 2014 at 4:09 PM

'Dreaded' may not be helpful, but it is accurate. I don't know a single woman who looks forward to their pelvic exam (although I can see how a cancer survivor might look forward to a 'clear' result). Although not sexual, the exam is uncomfortable both in position and in the 'goopy' feeling that follows for the rest of the day.

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1 reply
PowellTreeCare Lisa July 01 2014 at 4:16 PM

Plus that whole "treating you like a piece of meat" problem factors in too. I have had doctors and doctor's assistants do some very invasive things to me without bothering to warn me before they did them. If I was emotionally affected by it, I was dismissed - "Don't tell me nobody's ever done that to you before" was the battle cry the first time it happened. It was all I could do not to kick that woman in the face during the exam, and after her caring (cough cough) reply to my extreme shock at what she had taken for granted and done to me.

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gailneuman July 01 2014 at 11:44 AM

Whatever people came out with this for the ACP is off their rockers. A pelvic exam is the only way to find a vaginal or cervical growth, uterine growth like a fibroid or an ovarian tumor in a small curable stage.

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2 replies
corey39184 gailneuman July 01 2014 at 3:07 PM

You do not find ovarian cancer via a pelvic...If it was only that easy.

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PowellTreeCare gailneuman July 01 2014 at 4:18 PM

NO. It isn't. I had fibroid tumors within the lining of my uterus. I had numerous pelvic exams because I was having problems, and they kept coming up empty. It wasn't until I finally went in for exploratory surgery that they discovered the tumors. I ended up with a total hysterectomy because of it. I may have died if I had relied on the exam alone for diagnosis.

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coopdabomb July 01 2014 at 11:35 AM

Oh no AOL is in on the war on women.
How dare they tell a woman she doesn't need some medical care. We need to take this to the highest court in the land.

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corey39184 July 01 2014 at 11:46 AM

Got to say, as a boomer, I sort of agree. In my 20s, I got so many false alarms from docs (cysts that went away on their own in 2 mo. to biopsies that were benign)...lost trust. Last pap? By the time it got to the lab, cells were AWOL. Too much anxiety. For what?

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3 replies
Marilyn July 01 2014 at 2:09 PM

They've been saying this for years and, if I had believed it, I'd be dead right now. I had a total hysterectomy when I was 34 years old and was told I didn't need pap smears any more because I didn't have a cervix. However, I still needed hormone therapy so I was forced into having one every year anyway. Guess what ... I still had cervical cells and I had a ragingly abnormal pap smear for the first time in my life when I was 49 years old. It was significant enough that my OB/GYN sent me to an oncologist. Two surgeries and a round of chemo later, I USUALLY have normal pap smears now. No one likes to have a pap smear but you are playing with fire if you believe you don't need them any more. After what I've been through, I'll continue to have them for the rest of my life.

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1 reply
byfaith700 Marilyn July 01 2014 at 11:47 PM

Your information was helpful. I also was the same age when I had this same exact procedure and was told that it would not be necessary for pap smears because the cervix was removed.
After reading this I immediately made an appt. Thx

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bmitche July 01 2014 at 12:17 PM

My only concern is that the pelvic exam would allow doctors to feel and detect changes in the overies.

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1 reply
ctslair bmitche July 01 2014 at 8:05 PM

Might be relevant if they can FIND your ovaries; I had three exams, none of the docs could find my ovaries, much less the fact that I had fibroids. A totally noninvasive ultrasound revealed both and gee, no docs with all the finesse of a bulldozer rooting around in my insides.

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tren555 July 01 2014 at 12:57 PM

" Who cares if their cancers are caught too late?"
;;;;;;;;;;;;;;;;;;;;;;Diff between " caught too late " and caught earlier is just 203 months only.
Medical doctors just want you for longer period to " milk " money. They cannot solve any cancer at all.
Just hope for a false positive. In practice there is no survivors in cancer. Just false positive marching as survivors.

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3 replies
Linda July 01 2014 at 4:38 PM

I am in my early 60's and read this article this morning (and others)...I checked Medicare and guess what? They only pay for pelvic exam every TWO YEARS...I did not know this. Even if you have a supplemental plan
Medicare trumps all so I would have to pay out of pocket for yearly exam and let me tell you, something has to be done about this from the clinicians level. Talk about your war on women, we are here

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