Pelvic Exams Still Common Despite Lack of Scientific Support

Jenni Laidman

December 12, 2011

December 12, 2011 — US physicians routinely conduct annual pelvic examinations on women despite a lack of scientific evidence supporting their use, according to a study published in the December 12/26 issue of the Archives of Internal Medicine.

Analía R. Stormo, BS, and colleagues from the Division of Cancer Prevention and Control, US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, and researchers from the Soltera Center for Cancer Prevention and Control Research, Tucson, Arizona, reviewed data from the 2009 DocStyles survey of 1250 US internists, family practitioners, general practitioners, and obstetrician/gynecologists.

The physicians were asked how often they performed pelvic examinations for each of the following reasons: ovarian cancer screening, other gynecological cancer screening, as a requirement for starting oral or hormonal contraception, to screen for sexually transmitted infections, or as part of a well-women exam.

More than half of all physicians reported conducting routine pelvic exams as part of a well-woman exam, with 98.4% (246/250) obstetrician-gynecologists saying they conduct such tests routinely, 89.5% (545/609) of family practitioners or general practitioners reporting this as the rationale for routine testing, and 54.0% (211/391) internists reporting this reason for routine pelvic exams. The authors considered the exam "routine" if the physician answered he or she would employ the test "always" or "most of the time."

Obstetrician-gynecologists were most likely to conduct pelvic exams for any of the reasons provided in the survey (71.6% - 98.4%), followed by family practitioners and general practitioners (55.2% - 89.5%). Internists were least likely to do so, with a low of 29.7% reporting routine pelvic exams to screen for ovarian cancer, and a high of 54.0% using the screening for well-women exams.

"[U]se of pelvic examination for these purposes is not supported by scientific evidence and is not recommended by any US organization," the authors write.

Conducting such exams unnecessarily is not without problems, the authors note, particularly when used for early ovarian cancer detection.

"The accuracy of pelvic examinations for early detection of ovarian cancer is poor," with a false-positive rate of 98%, the authors write, leading to "overtesting and undue anxiety."

In addition, an invasive pelvic exam for sexually transmitted disease or before prescribing hormonal contraceptives may discourage women from seeking contraceptives or deter women from routine screening for sexually transmitted infections, the authors write.

Physicians in the survey were randomly selected from the Epocrates Honors Panel of 156,000 US physicians to match the proportion of physicians in the American Medical Association Physician Masterfile by age, sex, and region. Most were men (70.2%), white (74.3%), and in a group practice (63.4%).

Traditionally, pelvic exams were performed in conjunction with an annual Papanicolaou test for cervical cancer, but in 2003, the American College of Obstetricians and Gynecologists recommended the screening be reduced to once every 3 years if a Papanicolaou test accompanied by screening for human papillomavirus is negative.

The research is supported in part by an appointment to CDC's Research Participation Program, administered by the Oak Ridge Institute for Science and Education through an interagency agreement between the US Department of Energy and the CDC. The authors have disclosed no relevant financial relationships.

Arch Intern Med. 2011;171:2053-2054. Extract

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