A woman's yearly health visit often involves a pelvic exam — a procedure some find uncomfortable and embarrassing — but new recommendations say many women do not need to have this procedure routinely.
The recommendations, from the American College of Physicians (ACP), say that women should not undergo annual pelvic exams unless they have symptoms of possible pelvic disease — such as abnormal bleeding, pain or urinary problems— or are pregnant.
"Routine pelvic examination has not been shown to benefit asymptomatic, average risk, non-pregnant women," Dr. Linda Humphrey, a co-author of the guidelines, said in a statement. "It rarely detects important disease and does not reduce mortality, and is associated with discomfort for many women," and can lead to false positive results, Humphrey said.
For healthy women with no symptoms, the procedure's harms outweigh its benefits, the ACP said. The group's review found that the ability of pelvic exams to catch ovarian cancer and other treatable diseases, such as certain infections, is low. What's more, some surveys have found that about a third of women say they have experienced pain discomfort, fear, embarrassment, or anxiety from the procedure. [5 Things Women Should Know About Ovarian Cancer]
During a pelvic exam, a woman places her feet in stirrups, and the doctor inserts an instrument called a speculum in order to view the vagina and cervix. Next, the doctor places two fingers in the patient's vagina and the other hand on her abdomen to feel for problems in the ovaries, uterus and bladder.
The new recommendations do not apply to Pap smear screening, which involves collecting cells from the cervix to screen for cervical cancer, and is recommended every three to five years, depending on a woman's age.
The recommendations are likely to be controversial. The American College of Obstetricians and Gynecologists (ACOG), a group with more than 58,000 members, recommends yearly pelvic exams for women ages 21 years and older, but acknowledges that "no current scientific evidence supports or refutes an annual pelvic exam for an asymptomatic, low-risk patient," a statement from the group said. Instead, the recommendation is based on doctor's experience treating their patients, ACOG said.
Ultimately, the decision about whether to perform a pelvic exam should be a shared decision between doctor and patient, ACOG said.
Dr. Melissa Goist, an obstetrician and gynecologist from Ohio State University Wexner Medical Center who was not involved with the new guidelines, said most gynecologists likely would not change their practice of offering yearly pelvic exams, and would instead follow the ACOG recommendations.
"I'm almost certain that, no gynecologist is going to change their clinical practice right now based on this ACP recommendation," Goist told Live Science.
However, Goist said that doctors can also feel reassured in skipping the exam on patients who do not wish to have the procedure because it causes them discomfort and anxiety.
In a recent survey, more than 95 percent of obstetricians and gynecologists said they would perform a pelvic exam in women without symptoms, and an estimated 62 million pelvic exams were performed in 2010, the ACP said.
"The pelvic examination has held a prominent place in women's health for many decades and has become more of a ritual than an evidence-based practice," Dr. George Sawaya and Dr. Vanessa Jacoby, from the University of California, San Francisco, wrote in an editorial accompanying the guidelines. "Ending such a prevalent practice with widespread support among women’s health providers will be met with formidable challenges," editorial said.
The editorial notes that the ACP did not review studies that look at whether pelvic exams can help detect noncancerous masses on the uterus and ovaries, which might lead some doctors to question the recommendations.
Still, "with the current state of evidence, clinicians who continue to offer the examination should at least be cognizant of the uncertainty of benefit and the potential to cause harm through a positive test result and the cascade of events that follow," the editorial said.
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