Do women really need a yearly pelvic exam?

Woman on a gynecology office about to be examined (iStock)

Experts are still debating whether women need a pelvic exam at their yearly visit to a gynecologist, according to a new report.

The report comes from a government-appointed expert panel that reviewed hundreds of studies on pelvic exams and concluded that there isn't enough evidence to make a recommendation either for or against pelvic exams for women who don't have symptoms of gynecologic conditions and aren't pregnant.

The panel, known as the U.S. Preventive Services Task Force (USPSTF), said that more studies are needed to better assess the potential benefits and harms of routine pelvic exams.

In the meantime, the decision of whether a woman should have a pelvic exam should be shared between the patient and the doctor, the report said. The decision should consider the evidence, the patient's preferences and her risk factors for certain diseases, according to the report, which is published today (March 7) in the journal JAMA. [7 Facts Women (And Men) Should Know About the Vagina]

"Women, as patients, should be involved in the decision regarding whether to perform a pelvic examination, and clinicians should not require that the patient undergo this procedure to obtain screening, counseling and age-appropriate health services," Dr. Colleen McNicholas, an obstetrician/gynecologist at Washington University School of Medicine in St. Louis, and Dr. Jeffrey Peipert, an obstetrician/gynecologist at Indiana University School of Medicine, wrote in an editorial accompanying the recommendations.

A pelvic exam can involve a visual exam of the genitals and the inside of the vagina and cervix, as well as a "bimanual examination," in which 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. During the exam, the doctor looks for signs of certain conditions, such as yeast infections, genital warts, genital herpes, pelvic inflammatory disease, uterine fibroids, cervical polyps and ovarian cysts. However, some women find pelvic exams uncomfortable and embarrassing, and feel fear and anxiety before having one, said McNicholas and Peipert, who were not involved with the USPSTF's report..

In 2014, the American College of Physicians (ACP) said 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. At that time, the ACP said that the harms of screening (such as anxiety and discomfort) outweigh the procedure's benefits. However, the American College of Obstetricians and Gynecologists still recommends yearly pelvic exams, although the organization notes that the decision should be shared between the doctor and the patient.

For the new report, the USPSTF reviewed more than 300 studies on pelvic exams, but only nine of these  studies were rigorous enough to be included in the organization's final review.

None of these studies looked at the effectiveness of pelvic exams in reducing women's risk of dying from cancer or other diseases, or their effectiveness in improving women's quality of life. Very few studies have looked at pelvic exams' accuracy in detecting many gynecologic conditions, the report said. Although the USPSTF did find some studies looking at pelvic exams' accuracy in detecting ovarian cancer, these studies generally found that pelvic exams weren't very accurate at detecting ovarian cancer.

What's more, none of these studies looked at women's level of anxiety tied to pelvic exams.

The USPSTF's conclusion "does not come as a surprise," given that few aspects of annual physicals have been carefully studied, McNicholas and Peipert said. But many doctors would argue that routine physicals provide an opportunity for doctors to counsel their patients and build trust. However, the assessments performed during a physical have varying levels of invasiveness, McNicholas and Peipert said. [5 Things Women Should Know About Ovarian Cancer]

A pelvic exam can be "psychologically and physically intrusive," especially for women with a history of abuse or trauma, they said.

"Allowing [a woman] to control the decision to undergo an examination will improve the trust she has with her physician or clinician," McNicholas and Peipert said.

It's important to note that the new report does not apply to cervical cancer screenings, which are recommended every three to five years. The report also does not apply to screenings for chlamydia and gonorrhea; these screenings are recommended for sexually active women ages 24 and younger, and women older than 24 who have risk factors for these infections.

Original article on Live Science.

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