What your next gyno exam may not include
For doctors, pelvic examinations are a routine way to screen for abnormalities. But for many women, the procedure is uncomfortable and embarrassing.
Thanks to a new clinical practice guideline by The American College of Physicians, your next annual check-up might be less… invasive.
After reviewing 52 studies, the physicians organization concluded that annual pelvic examinations — in non-pregnant, adult women who do not have symptoms — are unnecessary. In other words, pelvic screening exams have served their time.
“It’s a Hallelujah for woman,” says Dr. Sandra Fryhofer, past president of the American College of Physicians. “The pelvic exam has been a yearly ritual for many patients. It’s uncomfortable, it can be painful and it triggers anxiety.”
For decades, the annual pelvic exam has been common practice during a well-woman visit. Sixty-two million were performed in the United States in 2010. The goal: find cancer or diagnose noncancerous masses and infection early. But experts’ opinion on that has changed.
What hasn’t changed are the cervical cancer screening guidelines for using a PAP smear test. This test is limited to visual inspection of the cervix, and taking cervical swabs.
“You still need regular cervical screening,” says Fryhofer. “You don’t start until age 21, then every 3 years, until age 65.”
Why the change?
The American College of Physicians, which published their guidelines on Monday, and the American College of Obstetricians and Gynecologists agree that an annual pelvic exam in asymptomatic and non-pregnant adult women does more harm than good.
For one, there is no evidence showing that screening pelvic examinations reduce rates of illness and death in asymptomatic adult women.
The authors also identified potential harms deriving from annual pelvic exams, such as patient discomfort, inconvenience and the cost of potentially unnecessary follow-up and treatment.
However, ACOG’s vice president for health policy, Dr. Barbara Levy believes the pelvic exam performed in the context of a gynecological visit allows a woman to address what may be sensitive and uncomfortable in any other circumstance.
“The question of doing a pelvic exam or not should be a conversation of the woman with her provider,” Levy said.
The new guideline for physicians doesn’t mean women should skip their gynecologist visit. If you are pregnant or are experiencing symptoms such as abdominal pain or abnormal bleeding, a pelvic examination may be necessary.
“This (new guideline) shows us that as a physician, we need to look at the rituals we are taught and question the value for our patients in doing these tests,” says Dr. Ranit Mishori, an associate professor of medicine at Georgetown University School of Medicine.
Mishori hopes that if pelvic exams are taken out of annual exams, it will encourages more women to see their doctor more often.
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