Is It Time for Medicine to Retire These Five Practices?

Stephanie Cajigal; Hallie Whitman

Disclosures

July 28, 2016

A time-honored medical practice was called into question last month when the US Preventive Services Task Force (USPSTF) issued draft guidance stating that there is insufficient evidence to recommend the routine use of pelvic examinations in asymptomatic, nonpregnant women. This leads us to ask: What other ubiquitous medical practices don't stand up to the evidence? Here are five common practices that some groups claim are no longer necessary. Do you agree that it's time to retire them? Tell us below.

Pelvic Exams During Routine Ob/Gyn Visits

What does the evidence say?

The USPSTF did their first-ever evidence review on routine pelvic exams and found no studies evaluating the benefit of pelvic exam screening on all-cause mortality, disease-specific morbidity or mortality, or quality of life.The task force concluded that there isn't enough evidence to recommend screening pelvic exams in asymptomatic women for conditions other than cervical cancer screening, gonorrhea, and chlamydia. And last year, the American College of Physicians (ACP) and the American Academy of Family Physicians (AAFP) both released guidelines advising against screening pelvic exams in asymptomatic, nonpregnant adult women. According to the ACP, routine pelvic exams aren't useful in screening for malignancies other than cervical cancer, may generate unnecessary evaluation and surgery, and can cause discomfort in women, leading them to forego gynecologic care.[1,2]

Who defends this practice?

The American College of Obstetricians and Gynecologists (ACOG) recommends annual pelvic examinations for patients 21 years of age or older. However, in a recent statement, ACOG president Thomas Gellhaus, MD, said that the society is reviewing the USPSTF recommendations and that the "limitations of the internal pelvic examination for screening should be recognized."[3] According to the statement, the women most likely to benefit from pelvic exams are those with possible genital tract problems, menstrual disorders, vaginal discharge, incontinence, infertility, or pelvic pain.

What's actually being practiced?

Most ob/gyns (98.4%) and general practitioners (89.5%) said they perform pelvic examinations during well-woman visits, according to a 2011 survey.[4]

Is there a middle ground?

Medscape expert commentator Andrew M. Kaunitz, MD, explained that while pelvic exams are not a good way to detect ovarian cancer, they are effective for picking up other irregularities, like pelvic prolapse and cervical polyps. He recently said that he continues to offer them to patients during well-woman visits, but for symptom-free patients in their 20s, he only performs pelvic examinations when indicated for cervical cancer screening.

Do you believe that pelvic exams should continue to be done routinely in asymptomatic patients?

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