ACP advises against routine pelvic exams

But ACOG continues to support the regular examinations

Women who are not pregnant, are healthy, and do not have an elevated risk of cancer or other diseases do not need to receive routine pelvic exams, according to new guidelines released by the American College of Physicians (ACP) in the Annals of Internal Medicine.

About 63 million pelvic exams were conducted in 2010 in the United States, according to an ACP editorial accompanying the recommendation.

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Why ACP recommends against the exam

ACP researchers reviewed studies of pelvic exams after the 2012 U.S Preventive Services Task Force (USPSTF) guidelines on cervical cancer screening did not address such exams.

 

According to Linda Humphrey, co-author of the new guidelines, two studies the group reviewed found that the "positive predictive value" of pelvic exams was less than 4% for ovarian cancer, while 11% to 60% of women said they felt pain or discomfort from the exam. One study found that the screening detected abnormalities in 174 of 2,000 healthy women of average risk for ovarian cancer, with follow-up tests resulting in 31 surgeries that found ovarian cancer in only two of the women.

The review also found evidence that pelvic exams can cause fear, anxiety, discomfort, embarrassment, or pain in approximately one-third of women, and that fear of the exam may cause some women not to seek needed treatment, Reuters reports.

Humphrey said, "In the absence of demonstrated benefit and in the presence of demonstrated harm, the equation just goes on the side of not doing something."

But, ACOG continues to support the exams

However, the American College of Obstetricians and Gynecologists (ACOG) released a statement disagreeing with ACP's recommendation, saying the group continues to "firmly believe in the clinical value of pelvic examinations" to help gynecologists detect incontinence and sexual dysfunction, "explain a patient's anatomy, reassure her of normalcy and answer her specific questions."

In particular, pelvic exams allow women an opportunity to raise concerns about medical issues, according to ACOG Vice President for Health Policy Barbara Levy (Bernstein, "To Your Health," Washington Post, 6/30; Seaman, Reuters, 6/30; Caryn Rabin, New York Times, 6/30).

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