Governing Body Tells Doctors to Do Away With Routine Pelvic Exams-- Should Women Even Get Physicals?
Part of my job as a doctor is keeping up on the latest advancements and developments in the field of medicine. I do this, as most all doctors do, to take the best care of my patients. Sometimes these advancements come in the form of slick new procedures to correct issues. Sometimes new tests come available to diagnose disease at an early stage. Other times it may be a new wonder drug used to treat an ailment. Of late, however, it seems that the biggest advancements have come in the form of evidence-based recommendations on what not to do. The two biggest recommendations have come in womens' health.
New Pelvic Exam Guideline and Rationale
First came the guideline to only perform pap testing every five years on women over 30 with previous normal pap/HPV testing. This month, The American College of Physicians (ACS) issued a new guideline recommending against screening pelvic exams in non-pregnant women without any vaginal or urinary complaints. As I share this news with women at their annual exams I get mixed reactions. Some are elated while some are taken back and cautious.
In the accompanying statement with the ACS recommendation, the authors reasoned that screening pelvic exams did not benefit women in the absence of genital or urinary complaints. According to one of the authors, the physical exam time, "is really crowded and I want to use my time in ways that are going to benefit women."
Support for the Guideline
Let's face it - women don't line up for pap testing and pelvic exams. They get them out of necessity, enduring the unpleasantry. But, what if they are not so necessary, or needed so frequently?
Yearly pap and pelvic was something we did, without scientific evidence, in line with other compulsory annual chores (like taxes). Extensive study on cervical cancer (the only thing that pap testing detects) concluded that the human papilloma virus (HPV) was the only cause and further that it takes years from new viral infection to cervical cancer. Study on pelvic exams showed virtually no use in a woman without any issues in this arena. This was corroborated by experts.
I must agree that after 17 years of performing routine pelvic exams, I have not detected any abnormality in woman without symptoms. Most women are elated to not have a pelvic exam. Some express concern or even conspiracy suspicions about Obamacare cutting services. Heeding the advice from the physician above, I have used the extra time it takes to have my patient change, re-enter the room with my nurse for the exam and then have the patient change back into their clothing (I still have patients change for the purpose of a skin exam and a breast exam but this is much quicker). In the extra time I can elaborate more on activity and dietary counseling that have better outcomes for benefit.
The new guidelines for pap and pelvic exams reshape the notion of the adult female "physical." The American College of Obstetrician Gynecologists (ACOG) stands behind its belief that a pelvic exam should be performed on an annual basis. The guidelines, in effect take away the female organs as the focus of the physical in lieu of the body as a whole. One cannot help but wonder if this stance is based in part on anticipated loss of business.
True, woman have more to their health than their female organs. They can still get cancer in non-female organs like the skin, lung, colon and more. Screening for heart disease and stratifying risk (blood pressure, family history, cholesterol) is as important for a female as a male. All of these aspects should be considered and covered at an annual wellness exam, a.k.a. "physical." It may be time to make this time with a doctor a true wellness exam, counseling on health, screening for disease and reducing risk for potential disease.
The quick pap-pelvic-breast exam should probably retire. his makes further sense in the growing trends toward consumerism. If a person pays for a comprehensive physical or if their insurance company only covers one annual physical performed by one doctor, it makes sense that a one-stop head to toe assessment with health counseling should be the choice. Gynecologic specialists who do not focus on primary, comprehensive care during their annual exams should do so or stick to specialized, problem-focused female care.
What This Means For You
If you are an adult woman getting routine annual exams with your health provider, be aware of a shifting emphasis. If you do not have genital-urinary issues at the time of your exam, there are new guidelines that this part of the exam is not necessary. These guidelines accompany new pap testing guidelines that state a woman with a normal pap and HPV testing over the age of 30 can wait five years until her next test.
Discuss these guidelines with your doctor so that you are on the same page in regards to your care. Further, make sure that your annual exam is comprehensive, screening additionally for non-female organ cancers, cardiovascular disease and other chronic diseases such as diabetes and mental illness. Make sure also that the time includes health promotion and counseling toward improving your health status.
Remember - health care should be caring for your health as a good use of your resources and time.