News & Commentary

Annual Pelvic Examinations Not Needed for Most Women

The annual pelvic examination might someday become a thing of the past. A draft ruling by the U. S. Preventive Services Task Force (USPSTF) says that evidence is “insufficient” to determine possible benefits or harms of the annual pelvic exam. The ruling does not apply to pregnant women or women with gynecological conditions or symptoms that need to be evaluated.

It’s the latest salvo in a debate in recent years about just how effective such exams can be.

And it’s a discussion medical directors at health insurance plans might have tracked, because the exams are expensive. They’re also time-consuming and male doctors need a female chaperone when performing one.

About 62.6 million such examinations were performed in the United States in 2010, according to the National Ambulatory Medical Care Survey.

This recommendation marks the first time the USPSTF reviewed the literature on pelvic exams. The task force noted that the evidence for pelvic exams is actually pretty thin despite their time-honored place in the health care of American women. Only eight studies evaluating them have been done over the past 60 years, according to USPSTF research.

“Although it is a common part of the physical examination, it is unclear whether performing screening pelvic examinations in asymptomatic women has a significant effect on disease morbidity and mortality,” the panel stated.

Public comment on the draft recommendation ended on July 25. The benefit of using pelvic examination alone to screen for gynecologic conditions other than cervical cancer, gonorrhea, and chlamydia is also unknown. The task force cited separate task force rulings “on screening for cervical cancer, gonorrhea, and chlamydia using tests that are often performed during a pelvic examination….”

The guidelines for cervical cancer screening say that pelvic exams can be used as a way to collect cells from the surface of the cervix and vagina. That test is recommended every three years for women aged 21 to 29; every five years for women aged 30 to 65.

Pelvic exams can cause fear and anxiety and be painful, especially for women who’ve been sexually abused. But no studies have quantified the amount of anxiety associated with screening pelvic examinations, guidelines state.

Professional organizations are split on the task force’s recommendation. The American College of Physicians and the American Academy of Family Physicians endorsed it. The American Congress of Obstetricians and Gynecologists (ACOG) still wants annual pelvic exams for all patients ages 21 and older if the doctor and patient think that’s the way to go.

“While ACOG found no evidence to support or refute the benefit of annual pelvic examination or speculum and bimanual examination in asymptomatic, low-risk patients, it concluded that the decision to perform a complete examination at the time of the periodic health examination should be a shared decision between the patient and provider,” the USPSTF recommendation stated.

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