A US medical task force said Tuesday that there is not enough evidence to support regular pelvic examinations in women who have no symptoms and are not pregnant, raising questions about the usefulness of the practice.
Pelvic exams are often part of a woman’s annual gynecological checkup, and may involve the physicians inserting his or her fingers inside the patient’s vagina and then feeling the outside of the lower belly for any bumps that might indicate cancer or abnormal growths. Rectal exams may also be included.
“The US Preventive Services Task Force has concluded that the current evidence is insufficient to assess the balance of benefits and harms of performing screening pelvic examinations in asymptomatic, nonpregnant adult women for the early detection and treatment of a range of gynecologic conditions,” said the statement, published in the Journal of the American Medical Association.
The task force did not issue a recommendation for or against pelvic exams and did not urge doctors to change their practice, but instead called for more research to provide evidence about the pros and cons.
The USPSTF also noted there is no change to its recommendations on regular Pap smear screenings for cervical cancer, which is called for every three years for most women.
Rather, it pointed out that for otherwise healthy, nonpregnant women, “it is unclear whether performing screening pelvic examinations in asymptomatic women reduces the risk of illness or death.”
The USPSTF is an independent panel of experts that makes recommendations about the effectiveness of preventive care services.
Its review of scientific literature found nine relevant studies that included more than 27,000 women.
However, no studies examined the effectiveness of the pelvic exam in reducing the risk of dying from cancer or any other cause, or improving quality of life.
The USPSTF is not the first body to question the pelvic exam.
In 2014, the American College of Physicians also said the manual pelvic exam was not necessary for most women and often caused discomfort for patients while also unnecessarily raising costs and encouraging false-positive findings.
“Many women express fear and anxiety before the examination and discomfort, pain, or embarrassment during the examination,” said an accompanying editorial in JAMA by Colleen McNicholas of the Washington University School of Medicine and Jeffrey Peipert of the Indiana University School of Medicine.
“Based on the recommendation from the task force, clinicians may ask whether the pelvic examination should be abandoned,” they wrote.
“The answer is not found in this recommendation statement, but instead in a renewed commitment to shared decision-making” with patients, who should be consulted about whether or not they would like a pelvic exam as part of their care, they said.
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