Last month, a commentary in the Journal of Women’s Health, the official journal of the American Medical Women’s Association, argued that ‘routine’ pelvic examinations serve little purpose and may be the reason that many women avoid preventive care. Additionally, the authors postulate that overuse of the pelvic examination contributes to high health care costs without any compensatory health benefit.
Annual testing of women for cervical cancer has been routine in the United States for decades: an estimated 65 million women had a Pap test in 2005. To best assess the risk for cervical cancer, the Pap test should be performed in tandem with a screening test for human papillomavirus (HPV). The HPV test is less useful in women aged 21-29 and young women have the most to lose from aggressive evaluation and treatment - there is a substantial risk to their obstetrical future while the risk of cervical cancer is exceedingly small.
The pelvic examination is not helpful in detecting early ovarian cancer and screening for sexually transmitted diseases can be accomplished via a urine test or a self-administered vaginal swab test. Home tests for STD screening are available via the internet in the United Kingdom. As a result of ‘routine’ pelvic examinations, older women face unnecessary hysterectomies for ovarian cysts and fibroids that are without symptoms.
Women still need to have screening for cervical cancer, but the frequency of these examinations can be less than many patients expect. Of course, women with risk factors and abnormal test results may need more frequent follow-up. There is some data that women older than age 30 should be screened every five years until the 60’s; after that, only when symptoms suggest a problem.
The authors conclude, “eliminating unneeded annual pelvic examinations will please many women and simultaneously free their physicians to provide other more needed care.”
Journal of Women's Health. January 2011, 20(1): 5-10.
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