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An end to routine pelvic exams? Not so fast, some say

Cutting through the confusion on conflicting guidelines

July 2, 2014

The American College of Physicians (ACP) recommended this week against annual screening pelvic exams for healthy adult women saying that, among other reasons, they aren’t an effective cancer detection tool. 

But in response, the American College of Obstetricians and Gynecologists (ACOG) issued a practice advisory reiterating their own guidelines recommending that they remain part of yearly well-woman visits.

So what is a woman to do in light of this seemingly conflicting advice?

For starters, it’s important to recognize that pelvic exams deliver benefits beyond cancer screening, said Dr. Linda Hipps, a gynecologist at the Seattle Cancer Care Alliance. 

“I still support an annual well-woman examination for healthy, asymptomatic patients, which would include a breast and pelvic exam,” she said. “The pelvic exam is not about a Pap test, nor is it a screen for cancer. As gynecologists, we need to continue to examine our patients and discuss their concerns, which often include birth control choices, vaginal infections, and STDs.”

Weighing the pros and cons

In the ACP’s report advising against routine pelvic exams, researchers noted there was no evidence in support of the pelvic exam as a disease-screening tool. The review also highlighted risks associated with pelvic exams, noting that the procedure can be psychologically or physically troubling to some women, and that the exam may lead to false-positive findings and associated unnecessary testing. ACP’s literature review spanned nearly 70 years of research and was published in the Annals of Internal Medicine. 

But ACOG counters that such screening provides other insights and has clinical value that allows gynecologists to “explain a patient’s anatomy, reassure her of normalcy, and answer her specific questions, thus establishing open communication between patient and physician.”

Hipps agrees and expressed concern that doing away with pelvic exams will add a certain amount of distance between a doctor and her patients, rather than bringing them into closer collaboration toward achieving the goal of good health.

 “I don't think that we have evolved to the ‘Star Trek’ era, where the physician can scan the patient with a handheld device and instantly make a diagnosis. We are not ready to abandon placing our hands on the patient at this time.” 

Understanding Pap tests

And while pelvic exams may not be able to screen for cervical cancer, there is no doubt that Pap tests can. The ACOG, as well as the American Cancer Society, recommend that women age 21 to 29 should have a Pap test every 3 years. Women age 30 and older should have a Pap test combined with a human papilloma virus (HPV) test every 5 years (this co-testing should continue until age 65). Women 30 to 65 can also choose to simply have a Pap test alone (without HPV testing) every 3 years.

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Joely Johnson Mork is a Seattle-based freelance health and science writer/editor whose work has appeared in numerous consumer health books, as well as in Prevention and TIME. Mork has a master’s degree in community health education and is a certified yoga instructor.

Solid tumors, such as those of the cervix, are the focus of Solid Tumor Translational Research, a network comprised of Fred Hutchinson Cancer Research Center, UW Medicine and Seattle Cancer Care Alliance. STTR is bridging laboratory sciences and patient care to provide the most precise treatment options for patients with solid tumor cancers.

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Fred Hutchinson Cancer Research Center is a world leader in research to prevent, detect and treat cancer and other life-threatening diseases.