A group of doctors are recommending against pelvic exams that gynecologists have routinely performed for decades on non-pregnant, healthy women during their annual checkups.
The American College of Physicians (ACP) published the recommendation in a new clinical practice guideline.
“Routine pelvic examination has not been shown to benefit asymptomatic, average risk, nonpregnant women. It rarely detects important disease and does not reduce mortality and is associated with discomfort for many women, false positive and negative examinations and extra cost,” said Dr. Linda Humphrey, a co-author of the guideline and a member of ACP’s Clinical Practice Guidelines Committee.
Humphrey pointed out that the guideline does not apply to Pap smear screening, only the pelvic examination. A pelvic exam is typically part of a woman’s routine wellness exam to find possible signs of a variety of disorders, such as ovarian cysts, sexually transmitted infections, uterine fibroids or early-stage cancer.
However many women find the procedure to be a dreadful experience, which consists of the doctor inserting a lubricated, gloved finger into the vagina and with the other hand, pressing down on her abdomen to check the shape and size of her uterus and ovaries. In what’s technically called a bimanual exam, some doctors also include a rectal exam as well while women are up in the stirrups.
The American College of Physicians, with 137,000 general internists and related specialists, is the nation’s second-largest physicians’ organization. The group’s recommendation, however, is expected to cause controversy.
The American College of Obstetricians and Gynecologists remains in favor of annual pelvic exams, stating that the exams help gynecologists “explain a patient’s anatomy, reassure her of normalcy and answer her specific questions.”
New York gynecologist Dr. David Fishman told the New York Daily News that pelvic exams are crucial for detecting serious diseases, particularly cancer. He cites one of his patients, Broadway, Tony Award nominated actress Valisia LeKae, 34, who in December was diagnosed with ovarian cancer.
LeKae said discomfort she felt during a pelvic exam led Dr. Fishman to send her for an ultrasound. His suspicions were correct. A small cyst was found and followed.
“Honestly, I was a little shocked when I read the guideline because it is an exam like this that helped save my life,” said LeKae, who is now the spokeswoman for the National Ovarian Cancer Coalition.
“I would ask women to make an educated response for their bodies, and to be as proactive as possible,” added LeKae, who underwent chemo and surgery and is now cancer free. “If I didn’t have those exams regularly I wouldn’t have known that the cyst had tripled in size, was cancerous and could have ruptured, spreading cancer all over my body.”
(Photo: Todd Pearson/GettyImages)