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Annual pelvic examinations have been routine care for women in the U.S. for decades and are widely tolerated as a necessary part of health maintenance. However, the latest guidelines from the American College of Obstetricians and Gynecologists (ACOG), recommend a decrease in the frequency of pap smear tests for most women, from annual to once every 2 to 3 years from ages 21-65, bringing into question: when a “pap” test is not needed, should the annual pelvic examination continue to be part of routine health exams for women?
In a Perspective published in the January 2011 Journal of Women’s Health, Carolyn Westhoff, MD, professor of Population and Family Health and Epidemiology at the Mailman School, reviews the value of the routine pelvic examination and its benefits and costs for healthy women who have no symptoms of disease. Dr. Westhoff cites data that shows that for such women the pelvic exam is not needed to screen for sexually transmitted infections (STIs), is not needed to initiate hormonal contraception, and is not beneficial for early detection of ovarian cancer.
Dr. Westhoff also considers some potential harm of pelvic exams in healthy women. These include exposure to additional diagnostic evaluations that often lead to unnecessary surgery and consuming time during a wellness exam that could be put to better use. She further points out that pelvic examinations are notoriously uncomfortable and so disliked that it may prevent many women from seeking routine care in the first place.
“The clinical trial data show no evidence that pelvic examination improves the early detection of ovarian cancer or diagnosis of other conditions in women who have no symptoms,” says Dr. Westhoff, who is also a Columbia professor of Obstetrics & Gynecology. “Overuse of the pelvic examination contributes to high healthcare costs without any compensa