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Are Annual Pelvic Exams Necessary? The Debate Continues

By HERWriter
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Do You Need an Annual Pelvic Exam? The Debate Continues Lifestock/PhotoSpin

Healthy women don't need regular pelvic exams the American College of Physicians (ACP) said in a new set of guidelines recently published in the Annals of Internal Medicine.

An expert panel appointed by ACP examined scientific research published from 1946-2014 that studied the effectiveness of the pelvic exam. The data suggested that pelvic exams don't reduce mortality and can lead to false alarms in 1.5-3 percent of cases, reported Wall Street Journal (WSJ).

"We found that the exam is not particularly good at detecting important disease, such as early ovarian cancer, and it can fool a physician into thinking she has detected an abnormality that, once you notice, will require further investigation," Molly Cooke, a member of the committee that wrote the guidelines said to WSJ.

The new guidelines only apply to the pelvic exam. The panel urged women to continue getting checked for cervical cancer.

Also, the experts emphasized that pelvic exams remain a necessary part of the evaluation in any woman with symptoms that could be related to a problem with the vagina, cervix, uterus, Fallopian tubes or ovaries, wrote Harvard Health Publications.

"There's no question that the Pap smear (which screens for cervical cancer) saves lives," Dr. Ranit Mishori at Georgetown University School of Medicine who wasn't involved in the new recommendation told NPR.org. "That part of the exam is not under question."

It is the bimanual exam that is under scrutiny. After the Pap smear, the doctor puts two fingers up the vagina and the other hand on the outside of the stomach. The doctor then examines the ovaries and uterus with both hands.

For decades, doctors thought the bimanual exam could help detect ovarian cancer. But studies haven't proven that to be true.

The American College of Obstetricians and Gynecologists said in a statement that women should consult with their health care providers about whether to have a pelvic exam.

Although the procedure is "not evidence-based," the organization said, it continues to endorse the exams because they can bring to light issues such as sexual dysfunction and incontinence.

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It's good news for American women, many countries ditched this exam long ago, it's of poor clinical value and exposes you to risk, even unnecessary surgery. Your Dr Carolyn Westhoff, ob-gyn, partly blames this exam for your high hysterectomy rates (1 in 3 women by age 60) and for the loss of healthy ovaries. I think many American doctors now rely on the income from the annual "wellness" exam and they'll fight to protect their business model. I'd urge women to consider the evidence and make an in informed decision. Pap tests: horribly overdone and used to create a huge industry in the over-treatment of CIN. Consider the new Dutch program, backed by the evidence and putting women first, no population pap testing, instead they'll offer 5 HPV primary tests or HPV self-testing at ages 30,35,40,50 and 60 and a 5 yearly pap test will ONLY be offered to the roughly 5% who are HPV+
Routine breast exams - not recommended, of no proven benefit, but they lead to excess.
Routine tests and exams that are not backed by the evidence simply expose you to risk. It should be a scandal that women have been used to maximize profits by the very group we're supposed to trust...and so many women have been harmed along the way.
The American practice of using a gynecologist as your medical provider probably partly explains why so many women end up worse off, in most countries women use a general practitioner for their healthcare and are only referred to a gynecologist if they have an actual gyn problem/issue or if they want a gyn to provide pre-natal care. I'm in my 50s and have never needed to see one so it's quite bizarre to think of girls and women heading off every year for a routine rummage-around, NOT a good idea, far more likely to harm you.

July 21, 2015 - 11:44pm
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We value and respect our HERWriters' experiences, but everyone is different. Many of our writers are speaking from personal experience, and what's worked for them may not work for you. Their articles are not a substitute for medical advice, although we hope you can gain knowledge from their insight.

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