#gynecology : is the annual pelvic preventive exam really necessary?

A pelvic exam for women who are not pregnant and do not have symptoms of cancer may be unnecessary, says the American College of Physicians (ACP) in a controversial new set of guidelines published Monday in the Annals of Internal Medicine. The ACP, which reviewed studies on the harms and benefits of pelvic exams, says the procedure does not detect disease as well as previously thought; it doesn’t reduce mortality; and it leads to many false positives, resulting in unnecessary testing and anxiety.

While the process is not painful, it’s certainly invasive. Now, ACP is questioning the necessity of this part of the checkup—commenting that “pelvic examination can cause anxiety, discomfort, pain, and embarrassment, especially in women who have a history of sexual abuse.”

But their guidelines are not being met with widespread praise. The American Congress of Obstetricians and Gynecologists (ACOG), considered the authority on reproductive health, still recommends yearly pelvic exams for women 21 years and older, though in a 2012 committee opinion, ACOG acknowledged that the “limitations of the internal pelvic examination should be recognized.” 

The very new recommendations are far from being consensus but they open the doors to continued debate over physical exams, and when they are appropriate.