An annual pelvic examination as part of a routine wellness visit has been the norm for women and their physicians for decades. But what if this checkup isn’t necessary on a yearly basis? That is exactly what the American College of Physicians (ACP) has recently suggested. They found there’s limited evidence showing pelvic examinations actually provide a benefit, and thus the APA is recommending it be removed from womens’ annual checkups.
For decades women and their doctors have used the annual pelvic examination to screen for cervical cancer, but studies have started to question whether or not this yearly event is actually beneficial for women, or if it’s simply become a routine. When screening for cervical cancer, the data shows there are several alternatives that are less invasive.
The ACP suggests a better alternative to the cervical examinations would be a visual inspection with cervical swabs for cancer and HPV. This is recommended because studies show “the diagnostic accuracy of the pelvic examination for detecting gynecologic cancer or infections is low.” The examination is still recommended for any woman who shows symptoms that something is wrong, such as abnormal bleeding, pain, sexual dysfunction, urinary issues or vaginal discharge.
According to the statement put out by the APA on July 1, 2014, Dr. Linda Humphrey, co-author of the guideline and member of the ACP’s Clinical Practice Guidelines Committee says that, “Routine pelvic examination has not been shown to benefit asymptomatic, average risk, non-pregnant women. It rarely detects important disease and does not reduce mortality and is associated with discomfort for many women, false positive and negative examinations, and extra cost.” Dr. Humphrey goes on to say that “this guideline does not apply to Pap smear screening, only the pelvic examination.”
Dr. Humphrey says skipping the annual pelvic exam is only for adult women with asymptomatic, average risk, and who are not pregnant. This should be seen as good news, especially for those women who are uncomfortable with having the examination on a yearly basis. Dr. Molly Cooke, former president of the ACP, also notes that “False positive findings can lead to unnecessary tests or procedures, adding additional unnecessary costs to the health care system.”
With this new information, what should women and their physicians do? In an editorial also published in the July 1 issue of Annals of Internal Medicine, Dr. George Sawaya and Dr. Vanessa Jacoby of the Department of Obstetrics, Gynecology and Reproductive Sciences at the University of California, San Francisco writes, “The pelvic examination has held a prominent place in women’s health for many decades and has come to be more of a ritual than an evidence-based practice…With the current state of evidence, clinicians who continue to offer the examination should at least be cognizant about the uncertainty of its benefits and its potential to cause harm through false-positive testing and the cascade of events it prompts.”
As with all health issues, it’s important to advocate for your own health. That means talking over the benefits and risks with your doctor for any procedure your doctor has recommended you having. The ACP recommendations could be the first step towards the ultimate phasing-out of the annual pelvic examination, at least for some women.