Editorial examines the need for routine pelvic exams
In new guidelines, the American College of Physicians recommends that doctors stop performing routine pelvic exams for most women. There is no evidence that pelvic exams are effective at detecting diseases like cervical cancer and plenty to suggest that the procedure provokes fear, anxiety and pain in many women, according to the new practice guideline. In an editorial accompanying the new guidelines, UCSF researchers discuss the efficacy of routine pelvic exams and possible reaction among women's health care providers to the new guidelines. The guidelines build on the Bixby Center's longstanding and rigorous research on pelvic exams, cervical cancer and birth control.
The pelvic exam has “held a prominent place in women’s health for many decades and has come to be more of a ritual than an evidence-based practice.” The new recommendations may be “controversial” since the exam has “long been considered a fundamental component” of women’s health visits. For instance, 2012 guidelines from the American College of Obstetricians and Gynecologists continued to recommend annual pelvic exams for all women ages 21 and older, and a recent survey revealed that US Ob-Gyns conduct the exam for the vast majority of patients. “Ending such a prevalent practice with widespread support among women’s health providers will be met with formidable challenges,” according to the authors.
Even if the new recommendations do not change why and how often doctors perform pelvic exams, they should “prompt champions of this examination to clarify its goals and quantify its benefits and harms.” Given current evidence, providers who continue to offer the exam should at least be aware of the “uncertainty of its benefits and its potential to cause harm through false-positive testing and the cascade of events it prompts.