Maybe You Don't Need a Pelvic Exam - Yet

Pelvic examinations in women may be scheduled more often than really needed

(RxWiki News) A lot of ladies have come to expect doctors need to check their private parts once a year. But the look down under may not be all that necessary.

Women's doctors may perform pelvic exams for questionable reasons or when the exam is not needed, according to a recently published study. These research findings point to the need to refresh doctors on when it's best to perform the exam on patients.

"These exams could result in unnecessary surgeries or women being falsely reassured,'' said the researcher in a press release.

"Ask your doctor if a pap smear is needed."

The study, led by Jillian Henderson, PhD, MPH, now a at Kaiser Permanente Center for Health Research in Oregon, surveyed 521 doctors who specialize in obstetrics and gynecology on the circumstances in which they would do a bimanual pelvic examination of their patients.

Researchers presented vignettes to participating physicians about healthy patients who did not have symptoms of diseases in their private parts, and were not yet due for their pap smear testing for cervical cancer. Patients were in groups of 18, 35, 55 and 70 years of age.

New guidelines created by the American Cancer Society, the US Preventative Services Task Force and the American Congress of Obstetricians and Gynecologists (ACOG), in which 90 percent of the doctors surveyed are members of, say that most women no longer need to have a pap smear each year.

Researchers did not ask doctors whether they did optional parts of the pelvic exam, including visually inspecting the genitals or a speculum examination to check the walls of the vagina and cervix.

They found that depending on patients' age, between 87 and 99 percent of the physicians said they would routinely conduct the exam in low-risk women who did not have symptoms.

At the same time, how often doctors felt it was important to get the test done varied, depending on the women's age groups.

A little more than a third reported they would test healthy 18-year-old women though the ACOG now recommends the exam not be performed routinely until the age of 21.

Only 69 percent of doctors felt it was important that 70-year-old women get the exam, and 98 percent said they would do it.

Almost all of the doctors reported they would examine 55-year-old women with no cervix, ovaries or uterus although only 57 percent felt the exam is very important for that particular group of women.

In addition, doctors said they would examine their patients for various other reasons, even if patients didn't have symptoms.

Such reasons include ensuring compensation for gynecologic care and meeting patients' expectations that they would be examined. Almost half said they test patients simply to reassure them, which is a common thought among doctors in the south and northeast.

Dr. Henderson says that the exams "could result in unnecessary surgeries or women being falsely reassured."

"We need to have more discussion over whether the benefits of these exams outweigh the harms, and if they should be part of a woman's annual checkup.''

The authors note that most of the doctors who responded to the survey were younger than those who did not respond, which may skew results. In addition, the doctors may be answering questions based on what they feel the researchers want to hear.

The study was published online November 12 in the American Journal of Obstetrics & Gynecology. It was funded by UCSF Mt. Zion Health Foundation, the Mentored Research Scientist Development Award in Population Research and the National Institutes of Health/ National Center for Research Resources/Office of the Director at the University of California, San Francisco-Clinical and Translational Science Institute program. The authors did not report any conflicts of interest. 

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Review Date: 
December 21, 2012