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17 December 2012
Pelvic exams conducted "because women expect them"

The pelvic exam, a standard part of the gynecologic check-up, is frequently performed for reasons that are medically unjustified, according to a new study by researchers from the University of California - San Francisco. The research, in the American Journal of Obstetrics and Gynecology, notes that doctors who continue to perform the pelvic exam say they do it mostly because women have come to expect it.

Traditionally, gynecologic check-ups have included, among other assessments, a manual inspection of a woman's cervix and uterus, and a Pap smear. Under recent guidelines by the American Cancer Society, most women no longer need annual Pap smears, which screen for cervical cancer. Now, questions are being raised by the medical community about the necessity of the annual pelvic exam for women with no gynecologic problems such as pelvic pain or unscheduled bleeding.

The study consisted of a nationwide survey of 521 practicing physicians specializing in obstetrics and gynecology, or gynecology alone. The doctors were asked to indicate whether they would perform a pelvic exam for female patients aged 18, 35, 55, and 70 years who had no symptoms of gynecologic diseases and did not require a Pap test. The study centered on the bimanual exam, not other components of a pelvic checkup such as a speculum exam and visual inspection of external genitalia which are often performed.

The researchers found that nearly all the physicians surveyed routinely would conduct the exam in asymptomatic, low-risk women. Furthermore, most of the doctors said they would perform the exam on a 55-year-old woman with no ovaries, uterus or cervix - and more than half considered such an exam to be very important for that woman.

Altogether, nearly half the physicians erroneously believe the exam is very important in screening for ovarian cancer, despite longstanding recommendations discouraging its use for this purpose.

Notably, many doctors said they conduct the exam in part for non-clinical reasons: because it reassures patients, because patients expect it, because it ensures adequate compensation for routine gynecologic care.

The researchers said their study shows a need to educate doctors about the appropriateness of the exam, especially to clarify its role in ovarian cancer screening. The study also should prompt a closer look at the evidence that supports the exam's usefulness for the reasons cited by surveyed physicians, they said.

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Source: University of California - San Francisco


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