Questioning the Annual Pelvic Exam (Is It Unnecessary?)

[HuckleB]

http://www.sciencebasedmedicine.org/?p=11218

"...

None of (the rationales for the annual pelvic exam) are supported by the evidence. Eliminating bimanual exams and limiting speculum exams in asymptomatic patients would reduce costs without reducing health benefits, allowing for better use of resources for services of proven benefit. Pelvic exams are necessary only for symptomatic patients and for follow-up of known abnormalities.

...

Is It Time to Abandon the Annual Pelvic Exam? Yes, I think so. The existing evidence indicates that omitting it in asymptomatic women would not affect health outcomes. This article is representative of a growing consensus in the medical community, especially in other countries; but many US doctors are still doing annual pelvic exams. I suspect (just my opinion) that they are afraid of looking stupid or getting sued if they miss something, or are clinging to what they were taught to do out of inertia. Meanwhile, science-based doctors are leaning away from annual physical exams in general. As this website says,

"The annual physical exam is beloved by many people and their doctors. But studies show that the actual exam isn’t very helpful in discovering problems. Leading doctors and medical groups have called the annual physical exam “not necessary” in generally healthy people."

Even in patients being followed for diagnosed diseases, the physical exam sometimes degenerates into a token ritual. I’ve noticed that although I have no heart or lung symptoms, my own doctors like to check my lungs at every visit by putting the stethoscope on four spots (right, left, front and back) for one breath each, and to check my heart by applying the stethoscope briefly to one spot. I tolerate it because I know it makes them feel better, but I consider it totally useless.
Admittedly, there is a human element involved: hands-on interactions and the perception of “doing something” can be reassuring and can enhance the doctor/patient relationship. But can’t a caring clinician attain those same benefits within the realm of science-based medicine? A doctor’s time is better spent on proven health screening measures and in educating and counseling patients than in carrying out nonproductive rituals."

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I found this to be quite interesting. This is not a subject I've come across before, or at least I don't remember coming across it before.

:hi:

[yellowcanine]

1. Why is it called a "pelvic exam" in the first place? Not as if the pelvis is being examined.

Pelvic Organ exam would be more accurate.

[pnwmom]

2. This is when they take Pap smears, which continue to be necessary. n/t

[HuckleB]

3. This is why it continues to be necessary to read the article before responding.

From the article:

"Pap smears have been proven effective in reducing morbidity and mortality from cervical cancer. Speculum exams are necessary to obtain specimens for Pap smears, but Pap smears need not be done annually and speculum exams need not be accompanied by bimanual exams. Current recommendations are to begin screening at age 21 and to re-screen at intervals of 2-3 years. New technology currently in development may eventually allow for equivalent screening without a pelvic exam."

[pnwmom]

4. Most people won't read the entire article and your title could give

a false impression that pelvic exams are unnecessary. And the frequency needs to be determined by a woman and her doctor, since the frequency depends on the situation of the woman and the type of test used. The American College of Obstetricians and Gynecologists recommends that all younger women (between 21 and 30) have annual pap smears, and the American Cancer Society recommends annual pap smears if a "conventional test" is used.

http://cervicalcancer.about.com/od/screening/a/screeningguide.htm

The frequency in which women get Pap smears is not the same for everyone. While one woman may need an annual Pap smear, another woman may only need a Pap smear every three years. How often a woman needs a Pap smear depends on several factors, like age, general health, and findings from previous Pap smears.

The American Cancer Society recommends that women have their first Pap smear about three years after they become sexually active or by age 21, whichever comes first. Subsequent Pap smears should occur every two years thereafter with a liquid based Pap test or annually with a conventional test.

The American College of Obstetricians and Gynecologists recommend women have an annual Pap until age 30.

SNIP

[HuckleB]

5. Thanks for the usual excuses.

No sale.

[CTyankee]

8. I have avoided pelvic exams for 3 years for several reasons:

over the age of 70 and without even one suspect pap test, no family history of any cancer whatsoever, good medical history in terms of diseases, and discomfort because of abdominal hernias (due to having the bad luck to have a complication from an elective surgery back in 07, a freak thing due to my body making scar tissue).

I had my last pelvic exam when I was 68. I had read that there is a growing number of docs who say women in my age group with no history of abnormal Pap tests can safely go without the Pap.

I continue, of course, to have yearly mammograms and to keep my blood pressure in check. My annual physical (with my Primary Care Physician) also includes an EKG and standard blood tests. Anytning suspicious I would report to him but thus far it has only been for treatment of bronchitis and for some allergic reactions causing skin problems and he treated those with appropriate medication which took care of the problem.

My mother lived to be 94. She and I thankfully have been blessed by not having chronic illnesses...

[Chemisse]

6. This is really interesting. These exams are driven by the need for

PAP smears, and it looks like the recommendations for these changed in 2009:

http://www.acog.org/acog_districts/dist_notice.cfm?recno=13&bulletin=3161

ACOG revised recommendations are:

# Women from ages 21 to 30 be screened every two years instead of annually, using either the standard Pap or liquid-based cytology.
# Women age 30 and older who have had three consecutive negative cervical cytology test results may be screened once every three years with either the Pap or liquid-based cytology.
# Women with certain risk factors may need more frequent screening, including those who have HIV, are immunosuppressed, were exposed to diethylstilbestrol (DES) in utero, and have been treated for cervical intraepithelial neoplasia (CIN) 2, CIN 3, or cervical cancer.


This is good news for women!

It's funny; I was recently told by a nurse practitioner that, since I am negative for HPV, I won't need the annual PAP smear. I then switched PCPs and my new doctor tried to schedule me for one. I protested, and she continued to say I should get one, but really didn't have a compelling reason to offer for it. I guess that's the 'inertia' the article refers to - LOL.

[flamingdem]

7. I heard this too, now I don't know if I need a pap smear.. nt

[wishlist]

9. My doctor found my fibroid tumors with pelvic exam (then did ultrasound)

I had increased menstrual bleeding and cramps but nothing drastically serious or worth mentioning but during a routine physical my doctor could feel the presence of abnormal growths and immediately did an ultrasound during which benign fibroids and diverticulosis pouches were obvious. I chose to have myomectomy by laparoscopic procedure to remove the fibroids before they got bigger and more disruptive. I would not have wanted my doctor to skip the exam until the symptoms were bad enough for me to complain about especially if they had been cancerous growths.