July 7, 2014 — Although new guidelines from the American College of Physicians advise that healthy women can forgo routine pelvic exams if they are not pregnant, the practice may be unlikely to end any time soon, The Atlantic reports.
ACP said that its literature review found little evidence that the exams improve detection of ovarian cancer or bacterial vaginosis, or reduce morbidity and mortality rates.
By contrast, the American College of Obstetricians and Gynecologists' most recent practice advisory states that "the College continues to firmly believe in the clinical value of pelvic examinations" and that the decision on whether to perform one at well-woman visits should be shared "between healthcare provider and patient."
Barbara Levy, ACOG's vice president for health policy, said that although the exams may not help detect cancer, they do enable physicians to broach topics with patients that may not otherwise come up during a visit, such as sexual dysfunction or urinary incontinence. She explained, "Something may come up in an exam that will prompt me to ask a question (about an embarrassing topic)," adding, "Sometimes it's just in the context of the exam that the patient will open up."
Meanwhile, Levy noted that the ritual of the pelvic exam could be difficult to change because physicians will continue to do what they believe is best for their patients. She added, "What we have is a void [in evidence], and when there's a void in knowledge, you have to use your experience."
However, physicians should not require women to undergo pelvic exams before prescribing oral contraceptives, she said (Beck, The Atlantic, 7/1).
Washington Post Column Touts Pelvic Exams as Life-Saving
In the Washington Post's "To Your Health," JoAnn Symons, chair of Ovarian and Gynecologic Cancer Coalition/Rhonda's Club, writes that as "an ovarian cancer survivor, [she] strongly disagree[s]" with the new pelvic exam guidelines.
Symons writes, "There is no reliable screening test for early detection of ovarian cancer, which is why 81 percent of women found to have the disease aren't diagnosed until it is in its advanced stages, when fewer than half survive." She continues, "Until an effective screening test is developed, we need to use every tool we have, including cost-effective, quick-response pelvic exams" (Symons, "To Your Health," Washington Post, 7/1).
New York Times Editorial: Women 'Need To Make Their Own Judgments'
A New York Times editorial notes that while ACP and ACOG "have taken opposing positions on whether healthy, low-risk women with no symptoms should have an annual pelvic exam, ... both professional groups agree there is no credible scientific evidence that the annual pelvic examinations save lives. They simply disagree over whether that lack of evidence matters much." While the Times does not take a side in the debate, it points out that "medical groups and researchers have issued changing and sometimes conflicting recommendations on how often women should get a routine mammogram, how often to get pap smears, and now, whether to get an annual pelvic exam." The editorial concludes, "Women will need to make their own judgments about procedures that many of them, and their doctors, may have used for years as a matter of standard practice" (New York Times, 7/2).