Annual Pelvic Screenings More Likely to Harm Than Help?

Pelvic examinations are no longer recommended to be conducted during annual well-woman visits, according to new screening guidelines by the American College of Physicians. The recommendation, which does not change Papanicolaou (Pap) smears for cervical cancer screenings, only applies to women who are not pregnant or who do not have symptoms of pelvic disease.

According to the guidelines, pelvic examinations–which include “inspection of the external genitalia; speculum examination of the vagina and cervix; bimanual examination of the adnexa, uterus, ovaries, and bladder; and sometimes rectal or rectovaginal examination”–are conducted in asymptomatic women to screen for conditions such as cancer, infections, and pelvic inflammatory disease.

False Positives, Physical and Psychological Harm

Studies suggested that pelvic screenings were not associated with improved health outcomes, and the use of pelvic screenings over transvaginal ultrasounds showed no reduction in ovarian cancer mortality rates.  According to the guidelines, many false positive findings are also attributed to pelvic examinations, resulting in unnecessary laparoscopies, laparotomies, and other invasive procedures.

While analysis showed that pelvic examinations garnered poor results in detecting or diagnosing ovarian cancer and bacterial vaginosis, patients frequently reported harms such as fear, anxiety, embarrassment, pain, and discomfort, especially women with histories of sexual violence or with post-traumatic stress disorder. Physical harms such as urinary tract infections, dysuria (painful urination), and frequent urination were also reported.

Industry Response

“I don’t think women should get the impression that the bimanual exam is terribly harmful,” said Dr. Richard Wender, the chief cancer control officer of the American Cancer Society, in a Kaiser Health News (KHN) article. “It’s been performed on millions of women, and the vast majority haven’t experienced any benefit or harm from having it done.” Dr. Wender merely stressed that, in the short visits doctors have with patients, “we want to use that time as wisely as possible.”

In the past ten years, according to KHN, the American Cancer Society has not recommended an annual pelvic examination for healthy women. The changes to pelvic exam guidelines come on the heels of new recommendations for less frequent mammograms and Pap smears by the U.S. Preventive Services Task Force.

“Honestly, it concerns me,” said gynecologist and gynecologic surgeon Dr. Taraneh Shirazian in the KHN article. “We’ve had changes to the mammogram recommendations, the Pap smear, and now the pelvic exam. All of it means that women may opt not to visit their gynecologist as often.”