What your next gyno exam may not include
June 30th, 2014
05:54 PM ET

What your next gyno exam may not include

For doctors, pelvic examinations are a routine way to screen for abnormalities. But for many women, the procedure is uncomfortable and embarrassing.

Thanks to a new clinical practice guideline by The American College of Physicians, your next annual check-up might be less... invasive.

After reviewing 52 studies, the physicians organization concluded that annual pelvic examinations - in non-pregnant, adult women who do not have symptoms - are unnecessary. In other words, pelvic screening exams have served their time.

“It’s a Hallelujah for woman,” says Dr. Sandra Fryhofer, past president of the American College of Physicians. “The pelvic exam has been a yearly ritual for many patients. It’s uncomfortable, it can be painful and it triggers anxiety.”

For decades, the annual pelvic exam has been common practice during a well-woman visit. Sixty-two million were performed in the United States in 2010. The goal: find cancer or diagnose noncancerous masses and infection early. But experts’ opinion on that has changed.

What hasn’t changed are the cervical cancer screening guidelines for using a PAP smear test. This test is limited to visual inspection of the cervix, and taking cervical swabs.

“You still need regular cervical screening,” says Fryhofer. “You don’t start until age 21, then every 3 years, until age 65.”

Why the change?

The American College of Physicians, which published their guidelines on Monday, and the American College of Obstetricians and Gynecologists agree that an annual pelvic exam in asymptomatic and non-pregnant adult women does more harm than good.

For one, there is no evidence showing that screening pelvic examinations reduce rates of illness and death in asymptomatic adult women.

The authors also identified potential harms deriving from annual pelvic exams, such as patient discomfort, inconvenience and the cost of potentially unnecessary follow-up and treatment.

However, ACOG’s vice president for health policy, Dr. Barbara Levy believes the pelvic exam performed in the context of a gynecological visit allows a woman to address what may be sensitive and uncomfortable in any other circumstance.

“The question of doing a pelvic exam or not should be a conversation of the woman with her provider,” Levy said.

The new guideline for physicians doesn’t mean women should skip their gynecologist visit. If you are pregnant or are experiencing symptoms such as abdominal pain or abnormal bleeding, a pelvic examination may be necessary.

“This (new guideline) shows us that as a physician, we need to look at the rituals we are taught and question the value for our patients in doing these tests,” says Dr. Ranit Mishori, an associate professor of medicine at Georgetown University School of Medicine.

Mishori hopes that if pelvic exams are taken out of annual exams, it will encourages more women to see their doctor more often.

soundoff (454 Responses)
  1. Finally!

    All I can say is finally! There was no reason why to get birth control I needed to be tested for pelvic cancer.

    June 30, 2014 at 20:38 | Report abuse | Reply
    • Sayyas

      Ummm...yes there is. Birth control pills can make pelvic cancer worse if you have it. These types of cancers can feed off the hormones from the pills. I sure wouldn't want to make it grow and spread elsewhere faster than it already is.

      July 2, 2014 at 12:09 | Report abuse |
    • Another woman

      Agreed. That was a such an infuriating waste of time and money for me. My doc knows how I feel about cancer treatment – don't want it. I saw no need to waste time and money to screen me for a disease for which I would not receive treatment anyway. European women don't even have to get a script for birth control pills, much less a wasteful exam.

      July 4, 2014 at 05:05 | Report abuse |
    • Russian Judge

      Wrong, according to the Mayo Clinic: These factors may increase your risk of cervical cancer:
      Many sexual partners. ...
      Early sexual activity. ...
      Other sexually transmitted infections (STIs). ...
      A weak immune system. ...
      Cigarette smoking.

      July 8, 2014 at 18:21 | Report abuse |
    • Disagree

      I strongly disagree with new guidelines set by the ACP and ACOG. For the past 15 yrs., I have been consistent with my woman's yearly annual. This year my Ob/Gyn detected a mass outside my uterus, which was removed and benign. After my experience this year, I am a firm believer and advocate that a woman must and should get a yearly annual.

      August 21, 2014 at 16:37 | Report abuse |
  2. Lena

    Yeah, what timing this is. Now that the ACA is here, all of a sudden it seems that women don't need yearly mammograms or gyno check-ups. Who's lobbying for that–the Chamber of Commerce?

    June 30, 2014 at 21:57 | Report abuse | Reply
    • Gayle63

      In other words, the days of easy money made off of unnecessary testing are over. The days of harming women by insisting they get irradiated every year are over. The days of taking advantage of people's fear are over. We've been brainwashed to be dependent on the industrial medical complex.

      July 2, 2014 at 09:33 | Report abuse |
    • Russian Judge

      Gosh, Gayle, you must be right. After all, we just have the longest life expectancy of any generation in history. But of course, you don't think that has anything to do with medical science, do you?

      July 2, 2014 at 12:26 | Report abuse |
    • gladr

      You do know that it's still insurance companies that pay for those who have insurance and medicaid pays for others, same as always, right?

      July 3, 2014 at 17:25 | Report abuse |
  3. Barbara Ryburn

    Why stop Pap smears at 65 don't we matter after that?

    June 30, 2014 at 22:32 | Report abuse | Reply
    • Another woman

      You aren't high risk unless you have HPV or your mother took certain drugs like DES. It's a waste of time and money.

      July 4, 2014 at 05:06 | Report abuse |
    • Russian Judge

      Not correct, according to the Mayo Clinic: These factors may increase your risk of cervical cancer:
      Many sexual partners. ...
      Early sexual activity. ...
      Other sexually transmitted infections (STIs). ...
      A weak immune system. ...
      Cigarette smoking.

      July 8, 2014 at 18:22 | Report abuse |
  4. Barbara Ryburn

    Why stop Pap smears at 65 don't we matter after that?

    June 30, 2014 at 22:34 | Report abuse | Reply
    • Matea

      I believe what they wanted to say with that is that it should happen more often, perhaps every 1-2 years rather than every 3 years.

      July 1, 2014 at 05:59 | Report abuse |
  5. L

    This is kind of "stupid". They are still going to do a pap of the cervix. So they will still have to do most of what a pelvic exam does. This is all about the money and what a doctor can charge.

    July 1, 2014 at 07:59 | Report abuse | Reply
    • Russian Judge

      Yeah, yeah, sure. It's ALL just a big conspiracy.


      July 1, 2014 at 10:33 | Report abuse |
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  6. CMetz

    Am I the only one NOT surprised? The health care factories prey on our basic instinct of fear. Their fright-fest based array of "well patient" exams simply breeds more unnecessary exams. It is time their free pass on doing whatever increases their bottom line under the rubric of medical care ends. This report coincidentally comes out at a time when I noticed lately an avalanche of commercials and billboards by the health care factories. They need to advertise? Really? If we consumers have a choice, as the advertising wrongly suggests, it's time we put our foot down and say "no more!." btw ACOG should be ashamed of themselves for conceding that there is no reason for the exams yet still recommend them.

    July 1, 2014 at 10:22 | Report abuse | Reply
    • todlich

      You're right. They're all out to get you. The next time you have sever pain anywhere, stay home and drink grape juice or take a supplement or something.

      July 1, 2014 at 10:54 | Report abuse |
    • Gayle63

      Taking care of your health rather than relying on pills, scalpels, and dangerous tests is a good idea, todlich. I'm sure there are doctors who really do want to do a good job, but too many just follow "guidelines" without thinking through. I've seen more people hurt by incompetent doctors than helped by good ones.

      July 2, 2014 at 09:35 | Report abuse |
    • Russian Judge

      I very much doubt that is true.

      July 2, 2014 at 12:24 | Report abuse |
  7. James L. Whiteside, MD, MA

    PAP smears in women over 65 have a very low yield. If cervical screening has been reassuring up to this point or if the woman has had a hysterectomy, continued cervical cancer screening after age 65 is more likely to find a false positive than to find a true positive. Clearly there will be exceptions but as a routine screening it more often than not renders more harm than good. This is precisely the conclusion made of routine pelvic examination. This recommendation by the American College of Physicians is welcome but as far as I can tell, the American College of Obstetricians and Gynecologists still endorses annual pelvic examinations (there may be a new Committee Opinion in the works that has not yet been published). The reasons for routine visitation to a gynecologist seem to be thinning. The long-term implications of this are interesting to consider.

    July 1, 2014 at 10:44 | Report abuse | Reply
  8. cali girl

    A pelvic exam is no different then the "turn your head and cough" exam.

    July 1, 2014 at 16:12 | Report abuse | Reply
    • Russian Judge

      How do you know?

      July 2, 2014 at 07:49 | Report abuse |
    • Stanley

      Turn your head and cough is just like the pelvic exam. Both are unnecessary unless you have symptoms. I had a hernia operation and you don't wake up one morning with this problem. You do something that causes symptoms. Then you proceed to the Doctor.
      My wife had her thyroid Rx held as hostage this year, unless she summited to a pelvic exam. She switched Doctors and now doesn't have to be badgered into doing something unnecessary, embarrassing and costly. Have empathy for the ignorant women who are your patients. If they don't have pelvic symptoms, and are healthy and aren't pregnant, why have them go through the embarrassment so your Doctor can make double the money at the patient's expense and anxieties. This is a real form of sexual abuse and power over women.

      December 6, 2016 at 17:34 | Report abuse |
  9. J MD

    As a gynecologist, this discussion is near and dear to me. Pap smears are becoming less frequent, but periodic pelvic exams should still be done. The unfortunate advanced vulvar cancers that I have been referred were in women who had been seeing physicians regularly. Maybe they had had a hysterectomy, widowed or no longer sexually active, or with dementia or other health issues "above the belt". No one really looked until it was too advanced. Very few women are going to happily offer up for a pelvic exam, they would be more than happy to forego this "dreaded" exam. But I think if these women had had a physician (not necessarily a gynecologist) just look, and see that something didn't look right, these women could have a local excision rather than face a terminal diagnosis. I tell my patients who may have had a hysterectomy, or old enough to no longer need paps, that every few years, someone (can be the gynecologist or other medical physician) needs to look at the vulva and pelvis making sure everything still is healthy.

    July 1, 2014 at 18:42 | Report abuse | Reply
    • cali girl

      Thank you for your post. As a patient I have always looked at pelvic exams as part of the entire visit. Since I am visiting my doctor every three years (not my choice) I would like every test ran that is available.
      Hopefully women will speak loud about this and let it be known our needs.

      July 1, 2014 at 19:26 | Report abuse |

      my mother didn't go to the doctor at all and was diagnosed with ovarian cancer...fought it for 9 years and then lost the fight. my grandmother who decided that if her doctor didn't insist that she have a pelvic exam (she hadn't had one for 20 plus years) then that was a good thing...was just diagnosed with vulva and labia cancer. she had to have all her vulva, labia and groin lymph nodes removed surgically last month. MY POINT IS...the patient has to be willing to have it done and not rely on doctors demanding it. my sister and I get exams each year and will continue to get them...otherwise we would be in the same shape as our grandmother and mother...terminal or dead.

      July 2, 2014 at 10:42 | Report abuse |
  10. account killer!

    So...I don't get it. We should be happy that there's no more pelvic exams but still get a pap smear...which requires naked from the waist down and stirrups anyway. Look, you might as well feel my ovaries while you're there, what's the big advantage here? I think the author perhaps doesn't understand how a pap smear is obtained.

    July 3, 2014 at 14:20 | Report abuse | Reply
    • gladr

      It's not the author saying this. Reread the article and see where the recommendations are coming from.

      July 3, 2014 at 17:27 | Report abuse |
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