"This article has been edited to clarify ACOG's position on bimanual exams and Pap tests in adolescents."
Results of a nationally representative study indicate that many young women receive bimanual pelvic exams (BPEs) and Pap tests that may be unnecessary, and not in compliance with the latest guidance from the American College of Obstetricians and Gynecologists (ACOG).
ACOG notes that for an adolescent reproductive health visit, an internal pelvic exam may be appropriate if issues such as abnormal bleeding or discharge, or abdominal or pelvic pain is a concern, but that an adolescent may visit a gynecologist several times before a biannual exam is needed. If a speculum or bimanual exam is indicated, a thorough explanation should always precede the procedure. Patients can find information about a gynecologic visit in the ACOG FAQ document, "Your First Gynecological Visit (Especially for Teens)". Pap tests are not recommended until age 21.
Published in JAMA Internal Medicine, the new findings are from a cross-sectional analysis of the National Survey of Family Growth (NSFG) from September 2011 through September 2017 focused on a population-based sample of young women aged 15 to 20 years. The main outcomes were receipt of a BPE or a Pap test in the last 12 months and the proportion of potentially unnecessary examinations and tests.
Conducted by the National Center for Health Statistics, NSFG is performed by trained personal interviewers and some respondents answer the questions using a computer-assisted self-interview. Of the young women surveyed, 4.8% were pregnant, 22.3% had undergone testing for a sexually transmitted infection (STI) and 4.5% received treatment or medication for an STI in the past 12 months. Only 2.0% reported using an intrauterine device (IUD) and 33.5% used at least one other type of contraception in the past 12 months.