The Howard Taylor International Lecture will tackle the pros and cons regarding annual pelvic examinations.
“Should Annual Routine Pelvic Examinations Go the Way of the Dinosaurs?” will take place at 4:15 pm today in Hall D.
The Department of Veterans Affairs (VA) and the American College of Physicians (ACP) commissioned a review to determine the value of annual routine pelvic examines in asymptomatic, average-risk women. According to the ACP guidelines, published in 2014, these women do not benefit from these annual exams and face potential harms.
This differs from ACOG Committee Opinion from the Committee on Gynecologic Practice released in 2012 and reaffirmed in 2014 that emphasized potential benefits of the exam while acknowledging the limitations.
Hanna E. Bloomfield, MD, MPH, associate chief of staff for research at the Minneapolis VA and professor of medicine at the University of Minnesota, will present the findings of the evidence review that was published at the same time as the ACP guidelines.
Paula J. A. Hillard, MD, FACOG, professor of obstetrics and gynecology and associate chair for medical student education at the Stanford University School of Medicine, will support the current ACOG recommendations and discuss what she and ACOG see as the benefits to annual pelvic examinations for some women.
Dr. Bloomfield said that her group found that no data existed that showed any morbidity or mortality benefits in asymptomatic, average-risk women excluding cervical cancer screening.
“The interesting thing is that according to all the literature that ACOG has published, they agree that there’s no evidence of benefit, but they continue to recommend it annually. Why?” Dr. Bloomfield said.
While the data is not as complete as everybody would like, she said, the information that will be shared during the debate points toward some definite trends, if not solid conclusions.
The evidence review included 52 published studies, including 15 that surveyed a total of 15,000 women about their attitudes and experiences of the Pelvic exam. These studies found that about a third of the women reported pain, discomfort, embarrassment, fear, and anxiety.
Pelvic exams also can lead to unnecessary exploratory surgical procedures, Dr. Bloomfield said. The data showed that about 1.5 percent of pelvic exams results in some type of surgical procedure. Even if the procedure ends up not finding any serious condition, she said, the patient still has a 15 percent risk of a major surgical complication.
“I would recommend that until we have evidence of benefits, let’s stop doing this uncomfortable procedure in women,” Dr. Bloomfield said.
Dr. Hillard said that ACOG does recommend a yearly visit, but that recommendation says that many, but not all, women will have a pelvic exam and clinical breast exam.
A big concern for Dr. Hillard comes from what she sees as confusion about what the ACP statement says. The media and the public have misunderstood what the ACP statement says and are not differentiating among the exam, cervical cytology screening, and a wellness visit, she said, and routine gynecologic, reproductive, and sexual health visits — with or without pelvic exams — are essential to health.
“A screening visit for many women is primary care,” Dr. Hillard said. “Many women of reproductive age see no other primary care physician other than their gynecologist, so they’re not going to learn about what’s appropriate for screening from anybody other than us as gynecologists.”
ACOG does understand the limitations to the exam, Dr. Hillard said, so that’s why the College says that the decision to perform a complete pelvic exam for asymptomatic patients needs to be a shared decision between the patient and the health care provider.
Dr. Hillard will talk about the benefits that pelvic exams offer women, including reassurance and building trust between a physician and patient.
“And we do find things that are asymptomatic that could impact quality of life that we find on an exam that wouldn’t otherwise be found,” she said.