Many Pelvic Exams Are Medically Unjustified

Nearly all obstetrician-gynecologists consider the bimanual pelvic examination a very important part of the well-woman checkup, and sometimes perform the examination unnecessarily in asymptomatic women, according to the results of a nationwide survey of 521 gynecologists and obstetrician-gynecologists in the United States.¹

The pelvic examination-manual inspection of the cervix and uterus in conjunction with a Papanicolaou (Pap) test-has been the center of annual well-woman examinations, which allow for an evaluation of a patient’s overall health and for the early identification of any budding health problems. To better understand why clinicians perform the examination, surveyed physicians were asked whether they would perform a bimanual pelvic examination in a series of vignettes involving asymptomatic patients aged 18, 35, 55, and 70 years who did not need a Pap test.

According to the study findings, nearly all of the physicians would perform routinely a bimanual pelvic examination in asymptomatic, low-risk women. Most physicians would perform the examination on a 55-year-old woman with no ovaries, uterus, or cervix, with more than half of surveyed physicians citing a bimanual examination to be “very important” in this scenario. In addition, 47% of physicians reported using pelvic examinations as a means to screen for ovarian cancer despite that this examination is not recommended for this purpose.¹ Other reasons given for performing the bimanual pelvic examination were adherence to standard medical practices (45%), patient reassurance (49%), and identification of benign conditions of the uterus (59%) and the ovaries (54%).

The updated guidelines for preventive care by the American Congress of Obstetricians and Gynecologists (ACOG), the US Preventive Services Task Force, and the American Cancer Society state that annual Pap tests are not needed for most women. ACOG also has recommended that the bimanual examination should not be part of a routine well-woman examination until age 21.² Despite these recommendations, about 87% of the physicians surveyed said they would perform this examination on 18-year-old healthy women. Physicians also said they perform the examination to reassure patients, to meet patient expectations, and to ensure “adequate compensation for routine gynecological care.”^1,2

Of concern is that these examinations could result in unnecessary surgeries or women being falsely reassured, said Jillian Henderson, PhD, MPH, lead author of the study.² “We need to have more discussion over whether the benefits of these exams outweigh the harms, and if they should be part of a woman’s annual checkup.”

Pertinent Points:
- Many pelvic examinations are performed unnecessarily, the results of which could result in unnecessary procedures or false reassurance.
- Many pelvic examinations are mistakenly performed to screen for ovarian cancer.

References:

1. Henderson JT, Harper CC, Gutin S, et al. Routine bimanual pelvic examinations: practices and beliefs of US obstetrician-gynecologists. Am J Obstet Gynecol. 2012 Nov 22. [Epub ahead of print.]
2. Study questions reasons for routine pelvic exams. Available at: http://www.eurekalert.org/pub_releases/2012-12/uoc--sqr121412.php. Accessed December 17, 2012.