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illions of healthy women undergo routine pelvic exams every year, but on Tuesday a panel of physicians and other medical experts cast doubt on this longstanding pillar of women’s preventive health care.

The US Preventive Services Task Force, which advises the federal government on preventive care, concluded that there is not enough evidence to recommend the procedure for healthy women. Studies have not shown that pelvic exams decrease a woman’s chance of developing illnesses such as ovarian cancer or of dying prematurely, the task force said.

Doctors who perform routine pelvic exams have vigorously defended their worth against previous criticism, but on Tuesday their organization, the American College of Obstetricians and Gynecologists, backed away from that firm stance, acknowledging there is little to no evidence that the exam benefits asymptomatic women.

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The task force finding is the latest reminder that many seemingly sensible procedures have little basis in science and fewer clear benefits than once thought. In recent years, procedures such as screening mammograms and PSA tests for prostate cancer, and even annual physicals, have turned out to be of questionable benefit.

Its conclusion applies only to women who are not pregnant and who do not have pelvic symptoms, such as pain or unusual bleeding. It gave the pelvic exam a grade of “I,” for “indeterminate,” meaning “we don’t have enough evidence to determine the benefits and harms,” said task force member Dr. Maureen Phipps, professor of obstetrics and gynecology at the Warren Alpert Medical School of Brown University and chief of OB-GYN at Women & Infants Hospital of Rhode Island.

The public can comment on the draft recommendation, which was accompanied by a 71-page review of the scientific evidence, through July 25. After considering the feedback, the task force will issue a final recommendation, which the federal government and some private insurers can use to decide what procedures to cover.

The recommendation is unrelated to screening for cervical cancer, which the task force highly recommends. But that can be done without a pelvic exam, an internal and external inspection by sight and touch.

In 2014, the American College of Physicians, which represents internists, reached a similar conclusion, finding that routine pelvic exams have not been shown to benefit asymptomatic women. The procedure rarely detects hidden disease and does not reduce mortality, the group concluded from decades of studies.

Obstetricians and gynecologists disputed the internists’ position; ACOG currently endorses annual pelvic exams for women 21 and older. But it is reviewing the task force’s draft recommendation, said ACOG president Dr. Thomas Gellhaus. His group’s current recommendation “is based on expert opinion” rather than rigorous scientific evidence, he said, and the “limitations” of pelvic exams “should be recognized.”

ACOG also acknowledges that “data do not support the necessity” of a pelvic exam before a woman starts oral contraceptives or to screen for sexually transmitted diseases such as chlamydia or gonorrhea. Those can be detected by urine samples or vaginal swabs.

There are two main reasons pelvic exams are of questionable value: their minimal benefits and their potential to cause harm.

Pelvic exams can find endometriosis, ovarian cysts, uterine fibroids, warts, herpes, pelvic inflammatory disease, and cervical polyps. But research has not shown that detecting and treating these before they produce symptoms is better than waiting for early symptoms to appear, said Dr. Amir Qaseem, vice president for clinical policy at the American College of Physicians. “You want to find things before they cause symptoms only if you have treatments that will keep full-blown symptoms from appearing,” he said. “We don’t have those for the conditions pelvic exams find.”

The exams can also cause harm (in addition to discomfort, for some women), said Phipps. Their rate of “false positives” — finding an apparent problem that isn’t there — ranges up to 46 percent. For instance, when a pelvic exam “detects” ovarian cancer, the chance that the woman actually has that often-fatal disease is 0 percent to 3.6 percent. But a woman given that frightening news, or the less dire news that she has a less serious condition such as ovarian cysts or fibroids, will typically undergo additional, sometimes risky, tests, including biopsies and even surgery for something that might never have affected her.

Pelvic exams can also give false reassurance. When an exam finds no sign of ovarian cancer, for instance, there is a chance the woman actually has it, according to studies reviewed by the task force. Such “false negatives” can cause a woman to ignore early symptoms of a potentially deadly disease, Phipps said.

An estimated 76 percent of preventive care visits to OB-GYNs include a pelvic exam, and US physicians performed 62.8 million of them in 2010, the last year for which the task force had data. Insurers typically reimburse doctors about $35 for them.

ACOG said its current position is not dictated by financial considerations. But if women opt out of pelvic exams, many might visit a gynecologist less often. And if gynecologists do not bill for a pelvic exam and the follow-up it often triggers, their incomes would decline.

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  • Comment to MegNP:

    Her comment to Stanley’s comment, was that his statement was drastic over-generalization. It makes OB-GYNs sound monstrous and malevolent. Some are very monstrous and malevolent. This may come to a shock to you but most women consider a pelvic exam one of the worst things a healthy women can have/with no gain. A woman can feel her abdomen and pelvic area to see if there are lumps or pain.

    There aren’t any lies to my statement/Stanley. My wife has gone to this gynecologist during and after her complete hysterectomy, approximately (6) years ago. The year before last year, she was badgered into getting a pelvic exam as well. They said that it had been awhile since her last pelvic and that she should get one. Yes, they even told her again that her insurance would pay for it.
    This last year they wouldn’t even do the blood work, unless she had booked a return office exam for a pelvic and to get her thyroid Rx.
    There is no exaggeration to this office wanting to do pelvic exams, without medical reasons or symptoms. If a Doctor was to talk with each patient and tell them that the pelvic exam was necessary and state what symptoms would need a pelvic exam, that would be different. The decision to have a pelvic exam should always be the patients, unless there are symptoms. Her gynecologist didn’t care and never asked her, even once, if she had any problems or symptoms. My wife even told her that she had a pelvic exam last year. It didn’t matter. They still demanded one if she wanted her thyroid prescription filled.
    There may be exceptions with some gynecologists. Still a family doctor is governed by real medical reasons/symptoms before doing a pelvic exam.
    Like I said before, never go to a gynecologist unless you are pregnant and/or have pelvic symptoms.
    If any of you have questions, go to the internet. You will find a huge amount of support in stopping gynecologists, giving pelvic exams, without medical reasons/symptoms and getting twice the money by doing so.

  • I too believe that healthy women who aren’t pregnant and don’t have any pelvic symptoms (abdominal pain, bleeding etc) don’t need a pelvic exam. Note: Women who haven’t had a hysterectomy still need a pap smear every (3) years or (5) if they get it with a combined HPV test.

    If you need your birth control pills renewed or need other Rx, go to your family doctor, not a gynecologist. Without symptoms, your family doctor will not perform a pelvic exam. Gynecologists will probably require you to have one, no matter what. They want you to believe that you would be expected to have a pelvic exam if you go to their office.

    Example: My wife went to her gynecologist this past year, to get her thyroid Rx refilled. They wouldn’t even take her blood test, unless she had an appointment already made for a physical/pelvic exam. Needlessly she left very upset and in tears. She made an appointment to her Family Doctor and got her blood work and Rx without a physical or pelvic exam.
    Additional Info: Before going to her Family Doctor, she called her gynecologist office back and questioned them on why they insisted on doing a pelvic exam. Their defense for requiring her to have a physical and pelvic exam, was that my wife’s insurance would pay for it.

    Have you ever wondered why your insurance premiums are always increasing? Gynecologists could care less about putting a woman through the most embarrassing thing a healthy woman could do without medical justification and symptoms. By doing a pelvic exam, they can charge over twice the amount of a normal office call.

    Best Advice: If you aren’t pregnant or don’t have pelvic symptoms, never go to a gynecologist to get your meds filled or anything else. Make your appointment with your General Practitioner or Family Doctor. Their guidelines require a real medical reason(s) and symptoms, for doing a pelvic exams.

  • First of all, there have been new released recommendations on routine pelvic exams. The American College of Physicians (Family or General Practitioner guidelines) in July 2014 completed a 50 year study on pelvic exams and have made the following recommendations:
    Healthy women who aren’t pregnant and don’t have any pelvic symptoms (abdominal pain, bleeding etc) don’t need a pelvic exam. Note: Women who haven’t had a hysterectomy still need to have a pap smear every (3) years or (5) if they get it with a combined HPV test.
    Women are perfectly capable in detecting pelvic problems on their own, and then this would warrant a pelvic exam. Routinely women have been herded into the exam room and put in the stirrups without symptoms and medical cause. They state that it is an expectation, no kidding. An expectation that has been going on for decades. The real expectation is that the gynecologist and charge you more than double if they can badger you into letting them do one to you. Doctors would educate women more, if they weren’t afraid of decreasing their business and income. Plus, you have to know they enjoy getting a look as well.

    If you need your birth control pills renewed or need other Rx, go to your family doctor. Without symptoms, they will not perform a pelvic exam. A gynecologist will probably require you to have one. They will be more than happy to put you in the stirrups, so they can more than double their fees.
    Example: My wife went to her gynecologist this past year, to get her thyroid Rx refilled. They wouldn’t even take her blood, unless she had an appointment already made for a physical/pelvic exam. Needlessly she left and went to her Family Doctor and got her blood work and Rx without a physical or pelvic exam.
    Note: Before going to her Family Doctor, she called her gynecologist back and questioned them on why they needed to do a pelvic exam. Their defense for requiring her to have a physical and pelvic exam, was that my wife’s insurance would pay for it. Have you ever wondered why your insurance premiums are always increasing. Gynecologists could care less about putting a woman through the most embarrassing thing a healthy woman could do without medical justification. By doing a pelvic exam, they can charge over twice the amount of an office call.

    Best Advice: If you aren’t pregnant or don’t have pelvic symptoms, never go to a gynecologist to get your meds filled. Make your appointment with your General Practitioner or Family Doctor. Their guidelines require a real medical reason for pelvic exams, not just to do them routinely, without symptoms.

    • I feel that this comment is an drastic over-generalization. It makes OB-GYNs sound monstrous and malevolent. This is certainly not the case. I myself am a women’s health nurse practitioner and work in an OB-GYN office. I would NEVER force a patient to have a pelvic exam, especially to simply refill medication. The American College of Obstetricians and Gynecologists encourage providers to make the decision of whether or not to do a pelvic exam with the patient. Some women report symptoms in a routine review of symptoms that may indicate issues never realizing that these symptoms could indicate a bigger issue. This subtle nuance could be missed by a provider not thoroughly familiar with women’s health issues. There is value in pelvic exams. I’ve witnessed this value over the ten years that I have been practicing. Advising women to avoid their OB-GYNs based on your wife’s experience is unfair and reckless, in my opinion.

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