Stay Safe; Discuss Pelvic Exams With Your Doctor

I hate to practice medicine by committee. But it seems that more and more often, medical advisory groups are coming out with recommendations that, despite the fact that they may have some merit to them, represent the opinion of too few doctors and are too far-reaching in their recommendations.

This is what is occurring with the latest public announcement from the American College of Physicians (ACP), stating that pelvic exams are not necessary for healthy women, are not efficient screening tools –  and can even be harmful.

Groups like the ACP will regularly review a bunch of studies and make a public announcement that essentially says, “Oh, by the way, we’re going to say that the way doctors have been practicing medicine for years is not applicable anymore.”

First, let’s delve into the facts here.

The ACP is using the term “harmful” inappropriately here. They are alluding to the anxiety created by a gynecologic pelvic exam, or the discomfort or embarrassment that some women may feel while getting a pelvic exam. I understand these exams can be uncomfortable; I’ve been a practicing gynecologist for over 30 years. But to me, the word “harmful” implies something that can hurt you or cause you to get sick. And the answer as to whether a gynecologic exam can cause physical harm is an overwhelming, “No.”

Second, the ACP alludes to the fact that the rate at which doctors discover anything abnormal during a pelvic exam is extremely low. This is true: A pelvic examination is performed to make sure there are no major undetected problems occurring in a woman’s pelvic region, from an ovarian tumor to a rectal or vaginal tumor. Every gynecologist  knows that. A pelvic exam was never meant to be the screening tool of choice in a general gynecological examination. But it’s part of the physical exam.

If this medical group wants to publicly issue warnings that may scare women, or drive a wedge between women and their gynecologists, they have achieved that. The American College of Obstetricians and Gynecologists still recommends yearly pelvic exams – and I would encourage them to respond to these new guidelines established by the ACP. Ultimately, statements like this one create confusion and stand in the way of doctors providing good medicine.

And to women out  there: This is a conversation that you and your OB-GYN should have. If you both feel that a pelvic exam is unnecessary, then don’t do it. Remember, routine physicals are becoming a thing of the past. Targeted physicals predicated on your family history and genetic predisposition for diseases and lifestyle experiences are the physical of the future.