Despite Recent Report, You Still Need an Annual Pelvic Exam
Recently, the U.S. Preventive Services Task Force (USPSTF) concluded that, “the current evidence is ‘insufficient’ to determine the balance of benefits and harms of the pelvic exam.” The USPSTF then made the recommendation to discontinue routine pelvic exams for women who are healthy and not pregnant. The broader media jumped on this as if it were fact, and an accepted change in practice. But does this lack of evidence mean there is no benefit to routine pelvic exams? Absolutely not.
The absence of evidence does not indicate the evidence of absence- If there is an absence of or limited evidence for the benefits of routine pelvic exams that does NOT mean there is adequate evidence to recommend against them.
The conclusion to discontinue the routine pelvic exam runs counter to the goals of improving women’s health through preventive care- Being asymptomatic is not the same as being healthy or not having a problem. The recommendation to perform pelvic exams only if women complain of problems will lead to missed opportunities to diagnose potentially fatal pelvic conditions. I understand that women do not like pelvic exams as they are intrusive, invasive and sometimes painful, but here is a fact I think most people are forgetting: they save lives. If you never check a temperature you’ll never find a fever.
Many others are also refuting the elimination of routine pelvic exams. As Dr. Maureen Phipps told the New York Times, “This is not a recommendation against doing the exam. This is a recommendation to call for more research to figure out the benefits and harms associated with screening pelvic exams. That’s the big message here.” She is the chairwoman of obstetrics and gynecology at Brown University’s Warren Alpert Medical School and was on the USPSTF task force. The American College of Obstetrics and Gynecology (ACOG) and other organizations are still recommending yearly pelvic exams for women over the age of 21.
So, at the risk of being redundant, I strongly disagree with the conclusion of the USPSTF draft evidence review, but particularly as it applies to postmenopausal women. There is a lot more that goes into the routine gynecological visit, including the pelvic exam. Women 18 years and older or anyone with risk factors like multiple partners, history of HPV, chronic infection or fertility issues should be seeking routine pelvic exams and pap smears. Contact our office to see if you should come in for a screening.
Dr. James A. Simon, MD, CCD, NCMP, IF, FACOG