New Pelvic Examination Guidelines Should Serve as Foundation for Talk with Your Doctor

Dorian Martin Health Guide
  • There are few things more detested by women than the routine pelvic examination. But it’s one of those examinations that we’ve learned to grin (or grit) and bear it! However, new guidelines released by the American College of Physicians (ACP) suggest that these examinations may not be necessary for protecting women’s health.

    In fact, the ACP’s new guidelines, which are based on a review of published research literature from 1946 until January 2014, recommend against performing screening pelvic examinations in asymptomatic, non-pregnant, adult women. The authors described pelvic examination as being the speculum examination of the vagina and cervix as well as the bimanual examination of the adnexa, uterus, ovaries and bladder. The guidelines do not address Pap smears for cervical cancer screening.

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    The ACP recommends that examinations be limited to visual inspection of the cervix and cervical swabs when screening for cervical cancer and human papillomavirus. However, ACP reports that pelvic exams are often performed in women who aren’t due to be screened for cervical cancer because many women and their doctors believe that these types of examinations should be part of annual wellness visits.

    This new guidelines were based on an evaluation of the published research studies as far as the relative incidence of disease and death. The literature review found that the diagnostic accuracy of pelvic examination for detecting ovarian cancer or bacterial vaginosis was low. Furthermore, the published literature suggests that the pelvic screening rarely detects non-cervical types of cancer or other treatable conditions. Pelvic examinations also did not lower ovarian cancer mortality rates. Additionally, researchers didn’t find the pelvic examination to be accurate in diagnosing other gynecologic conditions such as asymptomatic pelvic inflammatory disease, other benign conditions or types of cancer that differed from cervical or ovarian cancer.  

    Researchers also found that pelvic examinations have led to false positive findings in 1.5 percent to 3 percent of the cases and these findings can lead to psychological and physical harm. For instance, these examinations can lead to unnecessary laparoscopies, laparotomies, fear, anxiety, embarrassment, pain and discomfort. Additionally, the authors warn that women who have a history of sexual violence or post-traumatic stress disorder may have pain, discomfort, fear, anxiety or embarrassment during pelvic examinations. However, if you’re having symptoms or signs of gynecological issues – such as bleeding, discharge, pain during sex – the AOP recommends having the pelvic exam.

    Not surprisingly, the American College of Obstetricians and Gynecologists issued a statement that women should consult with their health-care providers as to whether they should have a pelvic exam. The ACOG continues to endorse having the exams because they can to identify symptoms that you might bring up to the doctor, such as urinary leakage, which can be treated or sexual dysfunction.

  • As I noted before, the recommendations don’t discuss Pap smears, which are still recommended for screening for cervical cancer. The American Cancer Society recommends that women get these exams every three to five years.

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    So what should you do about these conflicting recommendations? As always, I’d encourage you to talk to your own doctor. Use the guidelines as a point of discussion about what tests your doctor recommends and which tests your insurance will pay for. Together, you should come up with a plan that is tailored to your body, your history and your needs. That way, you’ll get the appropriate test(s) for your own specific situation.

    Primary Source for This Sharepost:

    Chen, A. (2014). Routine pelvic exam isn’t helpful, report says. The Wall Street Journal.

    Doucleff, M. (2014). Skip the stirrups: Doctors rethink yearly pelvic exams.

    Qaseem, A., et al. Screening examination in adult women: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine.

Published On: July 01, 2014