Routine pelvic exams and USPSTF

[spamforbrains]

If you’re a woman, you’ve most likely been forced to undergo repeated pelvic examinations throughout your lifetime in order to obtain birth control. Despite the fact that everyone acknowledges that a pelvic exam is completely unnecessary in order to obtain birth control, try convincing a doctor to give you any kind of birth control without doing one each and every year. They are not pleasant; many victims of sexual assault find them very traumatizing; and many non-victims find them to be rather upsetting.
The USPSTF has reviewed the evidence and to no one’s surprise, there is no evidence to support the use of routine pelvic exams. So next time your doc tries to perform one, come prepared to ask why and refuse if necessary. Oh, and you do not need a Pap smear every single year, which is widely acknowledged in clinical practice guidelines, so if the doc trots that one out, ask a lot of questions and be prepared to refuse.

http://www.uspreventiveservicestaskforce.org/Page/Document/draft-recommendation-statement157/gynecological-conditions-screening-with-the-pelvic-examination

Benefits of Screening
The USPSTF found inadequate evidence on the benefits of screening for a range of gynecologic conditions with pelvic examination. No studies were identified that evaluated the benefit of screening with pelvic examination on all-cause mortality, disease-specific morbidity or mortality, or quality of life.2

Harms of Screening
The USPSTF found inadequate evidence on the harms of screening for a range of gynecologic conditions with pelvic examination. A few studies reported on false-positive rates for ovarian cancer, ranging from 1.2% to 8.6%, and false-negative rates, ranging from 0% to 100%. Among women who had abnormal findings on pelvic examination, 5% to 36% went on to surgery.2 Very few studies reported false-positive and false-negative rates for other gynecologic conditions.2 No studies quantified the amount of anxiety associated with screening pelvic examinations.2

USPSTF Assessment
The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of performing screening pelvic examinations in asymptomatic women for the early detection and treatment of a range of gynecologic conditions. Evidence is lacking and of poor quality, and the balance of benefits and harms cannot be determined.

[JcWoman]

I only found them tedious rather than upsetting, but I still resented having to get them just to renew my BC prescriptions. When I got “fixed” at age 30, I was then able to skip the exams. I’ve been doing them irregularly, about every 2 or 3 years since then. I appreciate that doctors are trying to provide better health care for women’s “issues”, but I resent that politics has entered so deeply into it that they force their patients to endure testing based on nothing more than the clock. Same thing with mammograms for me: no outstanding risk factors but my doctors have all pushed for me getting one yearly from age 35. Why? Because I said so, or because that’s our practice’s policy. :dubious:

[Sattua]

Lately, some doctors have at least stopped requiring yearly pap smears. My doctor’s policy is that if you’ve never had an abnormal one in the past, you only get one every three years.

[psychobunny]

It’s not “some doctors”, it’s a standard recommendation that has been around for several years. ACOG guidelines from 2013. However, a pelvic examination is not the same thing as a PAP smear. There is controversy about whether a yearly pelvic examination is beneficial. (Internists say ‘no’, Ob/Gyns say ‘yes’-all agree that screening for STDs depends on sexual activity and partners).

The summary: don’t confuse a pelvic examination (which may be warranted yearly) with a PAP smear (which only refers to a particular swab which is one small portion of the pelvic examination and is NOT recommended yearly). FWIW, though, the current feeling is that a pelvic examination is not necessary for the prescription of birth control pills.