Say Goodbye to Annual Pelvic Exams?

Say Goodbye to Annual Pelvic Exams?

Could your annual pelvic exam be a thing of the past? One doctors' group is arguing that it should be. But not all women’s health experts are convinced. 

Following a systematic review of published studies, the American College of Physicians (ACP), an organization that represents internal medicine doctors, is now recommending against annual pelvic exams for most women, concluding that the exam’s potential harms outweigh its benefits. The ACP now says pelvic exams are only appropriate for women who are pregnant, have certain symptoms or are at an increased risk for gynecologic diseases.

Currently, gynecologists do the annual exams to look for cancers, infections or other conditions. The exam could help detect problems that may not present symptoms or that women feel embarrassed or uncomfortable talking about. Routine pelvic exams can also put a woman’s mind at ease, assuring her that she’s healthy and contributing to her overall well-being.

So with trends in medicine continuing to lean more toward prevention, why would the ACP argue against the exam?

Breaking Down the New Guidelines

During their systematic review of studies, which focused mainly on women of menopausal age and older, the ACP determined that the exam isn’t always effective. It rarely detects noncervical cancers, its accuracy in diagnosing conditions like ovarian cancer and bacterial vaginosis is low and it doesn’t prevent deaths among asymptomatic, adult women. The ACP noted that for many women, the exam is a major source of anxiety, embarrassment and discomfort, and false findings could lead to unnecessary follow-up procedures

This led the ACP to conclude that harms, including embarrassment, pain and discomfort, weren’t worth the benefits of the screenings.

Experts Weigh In

Despite these conclusions, not all women’s health experts are so quick to jump on board with the ACP’s recommendations. Kevin Windom, MD, an expert in gynecologic medicine and leading gynecologic surgeon, fears that the new guidelines could be “dangerous,” potentially discouraging women from the only preventive care they receive annually. And the American College of Obstetricians and Gynecologists states in their Practice Advisory on Annual Pelvic Examination Recommendations that “the decision about whether to perform a pelvic examination be a shared decision between health care provider and patient, based on her own individual needs, requests and preferences… However, the College continues to firmly believe in the clinical value of pelvic examinations…”

Patricia Geraghty, NP, one of the top-rated women’s health nurse practitioners in the US and expert in the field, says that she “vehemently disagrees” with the general guidelines, stating that “the pelvic organs are a part of the female body and deserve the same surveillance as any other part.”  She adds, “the trade-off between missing these issues because of anxiety and discomfort is not really an equation we seem to apply to detecting disorders of other body parts…no one recommends that we should stop providing weight management care because it makes the individual uncomfortable.”

What You Need to Know

So, with experts giving such different advice, what should women do?

Geraghty says, “I will advise my patients to continue with routine pelvic exams if they believe that means they are taking better care of themselves. I [would need] to do a very thorough verbal history with any patient that declines the exam so that I am also confident that she is getting the best care and we are not likely to be missing something.” So don’t scrap your annual GYN visit just yet – she advises that women see their gynecologist or a health care provider who will address their women’s health issues regularly.

She also says the following symptoms warrant a pelvic exam:

And above all, talk with your doctor about whether the exams are right for you. Dr. Windom suggests that women “be empowered with this information and with [their] own health. Ask questions. Use it to have a new, more informed dialogue with your doctor.”

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