15 December 2011

Unnecessary pelvic exams

Many doctors give women pelvic exams when they're not called for by guidelines, such as before prescribing for birth control pills, a US study said.


Many doctors give women pelvic exams when they're not called for by guidelines, such as before prescribing for birth control pills, a US study said.

That's worrisome because not only are the exams invasive, they also come with a risk of false positives that can lead to more unnecessary tests and procedures, said researchers at the Centers for Disease Control and Prevention in Atlanta, who conducted the study.

Women have become accustomed to getting a pelvic exam every year, they said, and doctors to giving them. But it's unclear if they serve any real purpose without any pelvic pain or signs of infection.

"Women should know that screening tests come with both harms and benefits, and the pelvic exam is not an exception to that," said Analia Stormo, who led the study, published in the Archives of Internal Medicine.

"We need to provide physicians with more of a clear message of when it's appropriate to use pelvic exams."

Stormo and her colleagues surveyed 1 250 doctors, including obstetricians and gynaecologists, family doctors and internists.

They asked how often they performed pelvic exams to screen for cancer or sexually transmitted infections (STIs) as a requirement before prescribing birth control pills or as part of a typical physical "well-woman" exam.

OB/GYNs were the most likely to say they routinely performed pelvic exams in each of those cases, but the majority of family and general doctors also did pelvic exams for every indication in question.

Full pelvic exam

While most doctors said they used the exams as part of a general well-woman exam, 95% of OB/GYNs and 55% of general doctors also screened for ovarian cancer using pelvic exams. Between 68 and 92% of those doctors used them to screen for STIs or as a requirement before prescribing birth control.

The researchers said there's no need to do a full pelvic exam to screen for STIs and that taking a urine test or swab is enough. In addition, there's no evidence that screening for ovarian cancer with a pelvic exam prevents women dying from the disease, or that it's needed before women go on birth control.

No matter how it's used, the exam can lead to so-called false alarms and over-diagnosis, when doctors find things that would never have caused any symptoms but are treated anyway.

Organisations including the American College of Obstetricians and Gynecologists recommend the exam as part of routine check-ups in most adult women, but other guidelines are inconsistent.

Other procedures and counselling should be top priorities during often time-strapped visits, and using the exams to screen for ovarian cancer may be especially problematic, doctors said.

It's also a very personal procedure.

"If a pelvic exam is considered so sensitive that it deters women from actually coming in for hormonal contraceptives or STI testing, that's a harm," said Mona Saraiya, one of the doctors who worked on the study.

(Reuters Health, December 2011)


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