A report published online Dec. 10 in the American Journal of Obstetrics and Gynecology suggests that many gynecologists and obstetricians perform annual pelvic exams for reasons that have little to do with medical need.
Researchers at the University of California, San Francisco surveyed a national representative sampling of 521 obstetricians and gynecologists about whether they routinely perform pelvic exams for women ages 18, 35, 55, and 70 who have no symptoms of gynecological illness and who did not require a Pap test (which screens for cervical cancer).
The physicians answered with a resounding yes. Almost all those surveyed said they routinely performed bi-manual, or two-handed, pelvic exams on women of all ages in the absence of symptoms or elevated risk of disease. Most said they did so because women have come to expect it and to provided reassurance about their health. Many physicians reported another reason: They can bill for such examinations, which make a well-woman patient visit more worth the doctor’s while, financially speaking.
The study comes at a time when the circumstances under which many kinds of screening practices, from mammograms and prostate-cancer-detecting PSA tests to the annual Pap smear, are being reevaluated. Such authorities as the American Cancer Society, the American College of Obstetricians and Gynecologists and the U.S. Preventive Services Task Force have for years been weighing whether the potential harms such practices may cause outweigh any benefits. At particular issue is whether overuse of such screening practices leads to too many false-positive results and unnecessary surgeries – and, for some women, misleading reassurances about their health. Bi-manual pelvic exam is not recommended for screening for ovarian cancer.
The physicians surveyed overwhelmingly indicated they’d perform routine bi-manual pelvic exams on 18-year-old patients, even though current guidelines call for starting such screening at age 21. At the other end of the spectrum, many of those surveyed said they’d perform such an exam on a 55-year-old woman with no ovaries, uterus or cervix.
Physicians in the northeastern and southern United States were more likely than those in other regions to say they considered bi-manual pelvic exams an important part of their patients’ care.
Do you have an annual bi-manual pelvic exam (as I do?). How important do you think it is to your health and well-being?