Regular Pelvic Exams Not Necessary for All Women, Group Says

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Most healthy women don't need an annual pelvic exam, the American College of Physicians (ACP) announced today in a new clinical practice guideline published in the Annals of Internal Medicine. The test—in which a doctor inserts his or her fingers inside the vagina while pressing down on the lower abdomen with the other hand—has the potential to do more harm than good, says the group.

Pelvic exams are often conducted in conjunction with pap tests during a yearly visit to either a primary-care physician or gynecologist. After reviewing nearly 70 years of published research on the topic, the ACP (a national organization made up of internal medicine doctors) says there's no evidence that the "bimanual" part of these exams—so called because the doctor uses both hands—actually helps to detect cancer or serious diseases in women who don't have obvious symptoms. They are also a source of discomfort or embarrassment for many woman, the authors say, and can lead to false-positive results that require more costly and anxiety-inducing testing.   

Instead of doing an annual pelvic exam, the ACP recommends that doctors only perform visual inspections of the vagina and cervix. They should also still conduct pap and HPV tests every few years as directed by current guidelines. (In other words, you still have to put your feet up in the the stirrups and let your doc take a look, and maybe a quick swab.) 

This only goes for women who aren't pregnant or experiencing strange symptoms, the guidelines note. Vaginal discharge, abnormal bleeding, urinary problems, or sexual dysfunction are all signs that may warrant more thorough screening, including a bimanual exam.  

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Not all doctors are on board with the ACP's findings, however. Taraneh Shirazian, M.D., assistant professor of obstetrics, gynecology, and reproductive science at the Icahn School of Medicine at Mount Sinai says that routine pelvic exams have helped her diagnose and treat early benign conditions, like fibroids and cysts, in many of her patients. 

"It allows physicians to feel the uterus and the ovaries, and get a sense of any abnormalities that might appear between visits," she says. "It gives us a baseline so we can follow women over the course of their lifetime, and it can be done at very little cost to both the doctor and the patient." 

The pelvic exam is still part of the American College of Gynecology's clinical guidelines, which were last updated in 2012. Shirazian says that because gynecologists follow ACOG's guidelines over ACP's, many doctors will—and should—continue offering pelvic exams. 

Hanna Bloomfield, M.D., a co-author of the evidence review on which the ACP's guidelines are based, points out that ACOG's recommendation for pelvic exams is not based on evidence of benefit but on expert opinion. "I agree with the ACP and others who believe that we should not be doing intrusive and uncomfortable tests that can lead to more unnecessary tests and surgery in asymptomatic healthy people if there is no evidence showing benefit," she wrote in an email.  

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Because of this discrepancy, you may need to talk with your doctor about whether he or she still recommends pelvic exams in general, and for you specifically, based on your medical history and current symptoms. If you have strong feeling against the screening, says Shirazian—say, if just the thought causes so much stress that you'd rather bail on the visit entirely—your doctor should respect your wishes and skip it in favor of a less invasive exam. 

An editorial published along with the new guidelines says that even if the ACP's guidelines don't change a doctor's mind about pelvic exams, they should prompt him or her to clarify with patients all the details of such a screening. "With the current state of evidence," the authors write, "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."  

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