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Monday, June 30, 2014

Doctors’ Group: No More Pelvic Exams?

gynecologist exam

By Kathleen Doheny

A routine pelvic exam, long a part of the annual visit to the ob-gyn or primary care doctor, is no longer recommended for women who aren’t pregnant and don’t have symptoms.

The new and controversial recommendation was released Monday by the American College of Physicians. Its members are internists, doctors who treat adults.

Mary Jane Minkin, MD, is a clinical professor of obstetrics and gynecology and reproductive sciences at Yale University School of Medicine and advisor for the WebMD menopause community. WebMD asked Minkin to discuss why the new recommendation was made and why some doctors may not agree with it.

What are doctors looking for during a pelvic exam?

The doctor looks for anything unusual in the ovaries, uterus, and other organs of the pelvis.

“We’re looking for several things,” Minkin says. A doctor will feel for masses, fibroids, cysts, and other unusual signs.

How and why was the new recommendation made?

The American College of Physicians looked at 52 published studies from 1946 through 2014. It could find no supporting evidence for routine pelvic exams. The possibility of finding cancer or other diseases in non-pregnant women without symptoms was low. Also, the doctors found some harms, such as incorrect exam results that led to unneeded testing. For some women, the exam also causes embarrassment and anxiety, they found.

The bottom line, according to Minkin, is that the doctors’ group is saying, “We don’t find enough on annual exams to make it worthwhile to put all women through an annual exam.”

The recommendation addresses only the pelvic exam, not the Pap smear to look for cervical cancer. In general, women should get a Pap smear every 3 years, according to guidelines from the U.S. Preventive Services Task Force, a panel of experts.

In April,  the FDA approved using an HPV test as a first one to use as a cervical cancer screening test.

The new recommendation on pelvic exams is at odds with that of the American College of Obstetricians and Gynecologists. In 2012, the gynecologists’ group continued to recommend annual pelvic exams in all women age 21 and older; those guidelines were reaffirmed this year.

What are the benefits of a pelvic exam?

“We do occasionally pick up a cyst or a mass,” Minkin says.

What are the harms?

“Occasionally we will be doing an unnecessary ultrasound, if we think we feel something,” Minkin says.

The doctors’ group found women most likely to report anxiety or pain during pelvic exams were those who had a history of sexual abuse.

What do you recommend women do?

”I tell my patients, when this question comes up, that I still think it’s a good idea to have an annual exam, but that it is controversial,” Minkin says. “I think a lot of women like the reassurance of [pelvic exams],” she says. She believes many doctors will continue to do them, as long as insurers continue to cover them.

The annual exam is a great opportunity to gauge how the patient’s life and general health are going, Minkin says. “I think a doctor picks up so much other stuff by an annual visit. The important thing to me is having the patient sit in front of me” and finding out health information just by talking.

The recommendations cover routine exams in women who are not pregnant. But when might a pelvic exam be needed for a non-pregnant woman?

If a woman has a symptom, such as bloating, she should ask for a pelvic exam, Minkin says. Bloating could point to a serious problem, such as ovarian cancer.

“If she has funky bleeding, before or after menopause, I would like her to have an exam,” Minkin says. Pain would also be a reason to get an exam, she says.

Posted by: WebMD Blogs at 4:29 pm

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