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Study Questions Routine Pelvic Exams

Wednesday, 19 December 2012 12:28 PM

A new women’s health study is challenging the need for doctors’ long-standing practice of performing a routine pelvic exam as part of a woman's gynecological checkup.
The University of California-San Francisco study, published online in the American Journal of Obstetrics and Gynecology, concludes pelvic exams are frequently performed for reasons that are medically unjustified and that medical practices should be changed.
George Sawaya, M.D. — a UCSF professor of obstetrics, gynecology, and reproductive science who helped conduct the study — said researchers found many physicians mistakenly believe the exam is important in screening for ovarian cancer.
The study, which surveyed obstetricians and gynecologists around the country, also shows many doctors perform the exam because women have come to expect it.
“The pelvic examination has been the foundation of the annual checkup for women for many decades, yet very little has been known about why clinicians perform it and if they believe it is useful,'' said Dr. Sawaya. "We set out to better understand their practices and beliefs.''
Annual medical checkups that allow physicians to assess overall health and pinpoint potential problems early traditionally include a manual inspection of a woman's cervix and uterus and a Pap smear.
But under updated preventive care guidelines by the American Cancer Society, the American Congress of Obstetricians and Gynecologists (ACOG), and the U.S. Preventive Services Task Force, most women no longer need annual Pap smears, which screen for cervical cancer. And the new UCSF study is raising questions about the need for the annual pelvic exam for women with no gynecological problems.
The study involved a survey of 521 practicing U.S. physicians specializing in obstetrics and gynecology. Among the findings:
• Nearly all the physicians said they routinely conduct the exam in asymptomatic, low-risk women.
• Most doctors said they would even perform the exam on a woman with no ovaries, uterus, or cervix — and more than half considered such an exam to be very important for that woman.
• Some 87 percent of the physicians said they would perform the exam on healthy 18-year-olds, even though ACOG recently recommended the exam not begin routinely until age 21.
• Nearly half the doctors erroneously believe the exam is very important in screening for ovarian cancer, despite longstanding recommendations discouraging its use for this purpose.
• Many doctors said they conduct the exam, in part, because it reassures patients, because women expect it, and because it ensures adequate compensation for routine gynecologic care.
The researchers said their study highlights a need to educate doctors about the appropriateness of the exam, and to clarify its role in ovarian cancer screening.
"These exams could result in unnecessary surgeries or women being falsely reassured,'' said researcher Jillian T. Henderson. "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.''

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Experts are challenging the need for performing a routine pelvic exam as part of a woman's health checkup.
Wednesday, 19 December 2012 12:28 PM
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