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March 9, 2017

The value of annual pelvic exams is unclear, USPSTF says

Daily Briefing

There is not enough evidence to say for certain whether healthy women need routine pelvic exams, according to new recommendations published in JAMA by the influential U.S. Preventive Services Task Force (USPSTF).

Pelvic exams typically examine the cervix, reproductive organs, and rectum. According to Reuters, doctors use the exams to look for certain sexually transmitted infections (STIs), pelvic inflammatory disease, fibroids, and cysts. The exams also screen for cancers of the uterus, cervix, and ovaries.

New guidance

This is the first time USPSTF has issued recommendations on pelvic exams. For the assessment, the task force reviewed eight studies on the topic—the only research that has been published since the late 1940s. Ultimately, USPSTF said the studies don't conclusively show the benefit or accuracy of the exams, nor do they establish how frequently women are harmed by false-positive results that can lead to unnecessary tests and procedures. The panel called for more research on the topic.

USPSTF advised women to confer with their doctor about when and how often to receive a pelvic exam based on their medical history, age, and other factors, NPR's "Shots" reports. The group also said the guidelines don't apply to pregnant women, Pap tests for cervical cancer, or screenings for certain STIs.

Maureen Phipps, a women's health researcher at Brown University, said, "The USPSTF strongly recommends that women be screened for cervical cancer, so we understand that women will receive a pelvic exam in that circumstance." She explained, "This new recommendation statement is about whether the pelvic exam by itself is a useful tool to screen for a variety of other gynecologic conditions."

Conflicting recommendations

The new USPSTF guidelines conflict with guidance from American College of Obstetricians and Gynecologists (ACOG), which recommends that women 21 and older receive a pelvic exam annually. But in a statement issued Tuesday, ACOG said it plans to reevaluate its recommendations based on the USPSTF report.

In 2014, the American College of Physicians (ACP), citing a lack of evidence and the potential harms of false positives, said routine pelvic exams should not be used as a screening tool for ovarian cancer among women with no symptoms.

In an editorial accompanying the USPSTF guidelines, George Sawaya of the University of California, San Francisco (UCSF), wrote that because of the conflicting guidance, doctors should inform patients of the uncertainty surrounding pelvic exams and discuss whether they are appropriate as needed. For instance, he said such exams may be appropriate if women have certain symptoms, such as unusual pelvic pain.

Sawaya also praised USPSTF's call for further research, writing that it is important that preventive care recomendations be supported by strong evidence. "We don't want to harm well people in our pursuit of trying to make them more well in the future," he wrote.

Kirsten Bibbins-Domingo, an internist and epidemiologist at the UCSF who chaired the panel said although the evidence for pelvic exams is inconclusive, women should not hesitate to get the care they need. "If a woman has concern about anything going on with her body she should absolutely schedule a visit with her doctor, and doctors should do the appropriate exams to understand symptoms," she advised (Neighmond, "Shots," NPR, 3/7; Rapaport, Reuters, 3/7).

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