Pelvic exams have long been a standard procedure during an annual women’s health visit with a physician or midwife.
A breast exam, pap smear and pelvic exam are routinely performed in the hope of catching any signs of health problems.
Pelvic exams have been common for quite some time, but preventive healthcare researchers have also kept them under scrutiny for years.
While it is not the first to reach this conclusion, the US Preventive Services Task Force has issued a statement saying that evidence is lacking for recommending routine pelvic exams for healthy women.
After looking at outcomes over recent years, they concluded that routine pelvic exams for asymptomatic women rarely detect hidden disease, and they don’t reduce mortality.
Why Are Routine Pelvic Exams Performed?
According to the old saying, ‘An ounce of prevention is worth a pound of cure’.
While this is true, not every type of exam can actually prevent or detect a disease before symptoms are present. Pelvic exams are performed in the hope of catching any signs of female cancers, sexually transmitted diseases, or other health problems, such as endometriosis, fibroids or pelvic inflammatory disease.
However, data is now showing that these health concerns are rarely detected in a pelvic exam prior to the onset of symptoms. If they are, there’s no evidence to suggest that treating these conditions prior to the appearance of symptoms has a benefit.
In other words, asymptomatic women are not likely to benefit from a routine pelvic exam.
For women with symptoms, a pelvic exam might be used along with other diagnostic measures to assess symptoms such as pelvic pain and irregular bleeding. For those with concerns about STDs, urine, blood and vaginal swab tests can be used to detect these infections.
Is There Any Risk To Pelvic Exams?
While they are uncomfortable, pelvic exams are still relatively safe and low intervention procedures. It isn’t likely that pelvic exams will result in injury, but they still carry some risk.
A woman who is asymptomatic and has an exam that reveals a possible concern might be subjected to unnecessary worry and further medical procedures.
In fact, the false positive rate for pelvic exams is up to 46%. This means a problem that isn’t actually there is ‘detected’. For example, of those women who are told, after a pelvic exam, they might have ovarian cancer, just 0-3.6% actually have this potentially fatal disease. This can lead to a lot of worry and even to procedures, such as a biopsy, for a ‘problem’ which otherwise might never have caused concern.
On the other hand, women who have an exam that comes back with negative results might develop symptoms shortly afterwards, and ignore them, assuming their health is fine. A woman can have a clear pelvic exam and still have ovarian cancer. An exam which rarely detects hidden disease can provide a false sense of security when early symptoms of disease become evident.
What Is The Problem With Routine Pelvic Exams?
Given the available information – that they rarely catch hidden disease, and they can provide false security – the two main problems with pelvic exams are:
- There is minimal benefit
- There is potential to cause harm
“You want to find things before they cause symptoms only if you have treatments that will keep full-blown symptoms from appearing. We don’t have those for the conditions pelvic exams find,” says Vice President for Clinical Policy at the American College of Physicians, Dr. Amir Qaseem.
Should I Skip Routine Pelvic Exams?
Current evidence doesn’t seem to support routine pelvic exams for healthy women without symptoms of disease. ACOG also acknowledges the limitations of pelvic exams.
If you’re unsure about whether or not you would benefit from a pelvic exam, you can discuss the benefits and risks with your healthcare provider. In the absence of symptoms, such as pelvic pain and irregular bleeding, most data doesn’t support a routine exam.
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