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Reassessing the Annual Pelvic Exam

WEDNESDAY, June 29, 2016 -- Women, the U.S. medical establishment isn't doing away with annual pelvic exams -- at least just yet. But a panel of U.S. medical experts has concluded there's no proof the dreaded checkup benefits healthy women who aren't pregnant.

In a draft recommendation released Tuesday, the U.S. Preventive Services Task Force said it couldn't weigh in for or against routine pelvic exams based on current evidence.

"The Task Force is calling for more research to better understand the benefits and harms of performing screening pelvic exams in women without any complaints or symptoms," said Dr. Francisco Garcia, a task force member. He is director and chief medical officer of the Pima County Department of Health in Tucson, Ariz.

The task force statement applies only to symptom-free, non-pregnant women. Women should still be screened for cervical cancer -- every three years from ages 21 to 29 and every five years from ages 30 to 65. Sexually active women should also be screened for gonorrhea and chlamydia, the task force said.

"Women with gynecologic symptoms or concerns should discuss them with their clinicians," said task force member Dr. Maureen Phipps, chair of obstetrics and gynecology at the Warren Alpert Medical School of Brown University in Providence, R.I.

Women all over will likely rejoice if the periodic exam falls by the wayside. Clothed only in a surgical gown with their feet elevated in surgical stirrups, patients endure prodding and poking while a doctor explores the vagina, cervix, uterus, fallopian tubes and ovaries.

Nearly 63 million pelvic exams were performed in the United States in 2010, according to the task force. But it found "insufficient" data to support their value. What evidence there is may be of poor or conflicting quality, the task force statement said.

While no studies evaluated the exam's ability to prevent disease or death, research did turn up harms such as unnecessary surgeries caused by "false positive" test results, the task force noted.

Other influential medical groups have also questioned the value of annual pelvic exams. The American College of Physicians in 2014 recommended discontinuing routine pelvic exams because of little evidence of benefit.

But the annual exam still has the support of the American College of Obstetricians and Gynecologists (ACOG), which believes these visits help build doctor-patient trust.

How the U.S. task force recommendation will affect current practice -- or insurance coverage -- remains to be seen. Although the U.S. government doesn't have to heed the panel's findings, it usually does. This, in turn, could alter coverage by Medicaid, Medicare and the Affordable Care Act as well as private insurance companies.

The panel will welcome public comments through July 25, and then issue its final statement sometime after that.

Dr. Jill Rabin is co-chief of the division of ambulatory care at Women's Health Programs-PCAP Services, at Northwell Health in New Hyde Park, N.Y.

She said she agrees with ACOG that all women should see their obstetrician/gynecologist annually.

"There's much more to an annual exam than a pelvic examination," she said, citing potential health problems that may not have obvious symptoms.

As for an annual pelvic exam, Rabin called for "shared decision-making between the patient and her physician."

More information

Visit the American College of Obstetricians and Gynecologists for its well-woman recommendations.

Posted: June 2016


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