Pelvic exam
If you've come to expect a pelvic exam as a routine part of your annual well-woman physical, you may be surprised to learn that health experts disagree over whether it is necessary - Hope Ricciotti MD
image by: Brandon Harvey
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Doctors Are Examining Your Genitals for No Reason
When a girl becomes a woman, she is initiated into a bizarre and mysterious annual ritual. She takes off her clothes, sticks her arms through a backless medical gown, reclines on an examination table, and spreads her legs. A doctor fits her feet into a pair of stirrups, looks at her genitals, sticks a cold metal speculum into her vagina, cranks it open, and peers in. When the speculum is removed, the doctor inserts a finger or two, and pokes around to feel the woman’s internal organs. Sometimes, the fingers examine her rectum, too.
In 2010, doctors performed 62.8 million of these routine pelvic examinations on women across America. In total, gynecological screenings cost the U.S. $2.6…
Resources
She Didn’t Want a Pelvic Exam. She Received One Anyway
Medical schools and students are grappling with an unsettling practice: Performing pelvic exams on unconscious, non-consenting patients.
Do Women Really Need A Yearly Pelvic Exam?
Experts are still debating whether women need a pelvic exam at their yearly visit to a gynecologist, according to a new report. The report comes from a government-appointed expert panel that reviewed hundreds of studies on pelvic exams and concluded that there isn't enough evidence to make a recommendation either for or against pelvic exams for women who don't have symptoms of gynecologic conditions and aren't pregnant. The panel, known as the U.S. Preventive Services Task Force (USPSTF), said that more studies are needed to better assess the potential benefits and harms of routine pelvic exam.
Gynecological pelvic exams & Pap tests 101
What you can expect at the gynecologist’s office.
If You’re a Healthy Woman, There’s No Evidence You Need an Annual Pelvic Exam
Annual pelvic exams for screening purposes (as opposed to diagnostic purposes, as in the case of a patient presenting physical symptoms) carry a high risk of false positives, which can lead to expensive and sometimes risky unnecessary biopsies or surgeries. There’s also the less-calculable but very real risk of false negatives, which can cause a woman to brush off symptoms of something like ovarian cancer if and when they do pop up. The new recommendation from USPSTF does not apply to Pap smears for cervical cancer screening in women aged 21 to 65—still the best way to detect the cancer when done every three to five years.
Is Performing Pelvic Exams on Unconscious Women Without Informed Consent Legal?
Despite widespread condemnation of the practice, performing pelvic exams on unconscious women for medical training, without explicit consent, is legal in 45 states.
When to Start With a Gynecologist?
A woman’s first gynecologist visit should happen at the age of 21 for cervical cancer screening, however, any woman or teenager who is younger than 21 and is sexually active should be seeing a provider who is comfortable with gynecologic care for annual chlamydia screening.
Women Are Reinventing the Long-Despised Speculum
The gynecological apparatus, designed by men, has a sordid history.
Doctors don’t know whether women really need those awkward pelvic exams
For some women, though, the exams may not be necessary. On Tuesday (June 28), medical professionals from the US Preventative Task Force (USPTF) conducted a major review of the existing scientific literature and found inconclusive evidence that pelvic exams are helpful for women who aren’t pregnant or don’t show unusual symptoms, like unexpected bleeding or discharge.
New Guidelines Advise Against Routine Pelvic Exams at the Gyno
Turns out they're not that beneficial after all.
Should you have an annual pelvic exam?
If you've come to expect a pelvic exam as a routine part of your annual well-woman physical, you may be surprised to learn that health experts disagree over whether it is necessary.
The Speculum Finally Gets a Modern Redesign
THE CURRENT DESIGN of the speculum, fashioned by American physician James Marion Sims, dates back to the 1840s. The device had two pewter blades to separate the vaginal walls, and hinged open and closed with a screw mechanism. Sims, sometimes called the "father of modern gynecology," used the speculum to pioneer treatments for fistula and other complications from childbirth. But his experiments were often conducted on slave women, without the use of anesthesia. So to say that the speculum was not designed with patient comfort in mind would be an egregious understatement.
Doctors Are Examining Your Genitals for No Reason
In an editorial also published in Annals, internists George Sawaya and Vanessa Jacoby of the University of California–San Francisco, conclude that the pelvic examination has “become more of a ritual than an evidence-based practice.” Sawaya told me that the routine pelvic exam is such “a foundational cornerstone” of gynecology, it’s hard to even trace its origins. The new report urging doctors to reverse course will be “very controversial,” Sawaya says. “I expect a lot of physicians to raise their eyebrows.”
4 medical tests that are awkward, embarrassing, and unnecessary
Changing into a paper-thin hospital gown, hoisting feet up into stirrups and being probed vaginally with a speculum is, to say the least, an unpleasant experience. And it's something that lots women go through every year with a pelvic exam during an annual well-woman visit to the gynecologist. The American College of Physicians, which represents the country's internists, issued new guidelines on July 1 that specifically recommend against annual pelvic exams for healthy women who are not pregnant.
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