If Pelvic Exams For Healthy Women Aren’t Helpful, Why Do We Still Do Them?

Provider doing a pelvic exam
Photo: Wendy Maeda
By Guest Contributor |

By Amy Romano

Pelvic exams have historically been a routine part of healthcare for millions of women and as a midwife I have performed hundreds throughout my career. But a new recommendation may change this practice moving forward.

In late June, the U.S. Preventive Services Task Force concluded that pelvic exams have no proven benefits for healthy women. After reviewing decades of research, the task force determined that routine pelvic exams rarely detect hidden diseases and do not reduce death rates. The conclusion applies only to women who are not pregnant and who do not have potentially problematic symptoms like pain or heavy bleeding.

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And the conclusion refers only to pelvic exams, which involve using a speculum to examine the vagina and cervix, and a bimanual examination of the uterus, fallopian tubes, ovaries, and bladder. Women still need to get Pap tests, which screen for cervical cancer (though for many women the tests can be done infrequently), and may need to be tested for sexuality transmitted diseases.

Given that more than 60 million pelvic exams are performed each year, it’s  important to understand the recommendation and to talk about what it means to women and to providers. Routine screenings like pelvic exams should be supported by evidence that they actually benefit women’s health. In this case, there is little data to show that they do.

Despite this lack of evidence, health care providers continue to perform pelvic exams, possibly more out of ritual than evidence-based practice, notes Dr. George Sawaya, a professor of obstetrics, gynecology and reproductive sciences at the University of California, San Francisco.

It’s not just that the exams have questionable value in keeping women healthy. They can also cause harm to women:

For instance, when a pelvic exam “detects” ovarian cancer, the chance that the woman actually has that often-fatal disease is 0 percent to 3.6 percent. But a woman given that frightening news, or the less dire news that she has a less serious condition such as ovarian cysts or fibroids, will typically undergo additional, sometimes risky, tests, including biopsies and even surgery for something that might never have affected her.

And even if the exam does find endometriosis, ovarian cysts, or pelvic inflammatory disease, for example, the research does not show that detecting these conditions before a woman is symptomatic is better for women than waiting for symptoms to appear. Especially when we don’t have treatment to prevent the symptoms from occurring or the disease from progressing.

In seven years of performing pelvic exams on healthy, asymptomatic women, I have never once discovered a chance finding that turned out to be a disease. I have had false positives that required further testing. False positives and false negatives are both associated with routine pelvic examination.

The American College of Physicians (ACP), an organization representing internists, released similar recommendations in 2014 against routine pelvic examinations. The group’s analysis of published literature on human subjects from 1946 through January 2014 showed that the harms of regular pelvic exams outweigh any potential benefits.

The American College of Obstetricians and Gynecologists (ACOG) still recommend, based on “expert opinion” (not evidence), yearly pelvic exams for women 21 years of age and older.

The ACP and the task force’s findings are useful. But if we are going to prioritize patient-centered care, it’s even more helpful to address how providers can and should use this information to provide optimal care to women. The group released guidelines alongside their recommendations that include advice to help doctors and patients understand the benefits, harms, and costs of the pelvic examination so they can pursue care together that improves health, avoids harms, and eliminates wasteful practices.

There is actually quite a bit of evidence that attending to women’s emotional well-being may be more valuable than many of the routine medical tests we put them through.

It’s important that we strive to provide woman-centered and respectful health care for women. To do this, we need to invite women into a conversation about their health and health care. We need to listen to women when they say pelvic exams can be uncomfortable, painful, or even traumatic. It’s up to health care providers to defer the exam in favor of doing something a woman actually needs or wants. If pelvic exams do not fit it into either of those categories, it may be time to ditch them.

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12 Comments

  1. Jacqueline L. says:

    As an editor who has contributed to several updates of Our Bodies, Ourselves–and as a longtime feminist activist–I suspect that the real reason pelvic exams are done “routinely” on healthy women is that they are profitable for the medical professional who does them. Most women don’t know much about medical decisions regarding testing (let alone treatment), and far too many women do not have the option of seeing female gynecologists. Medical and government organizations that make “recommendations” need to encourage patient education and decision making.

  2. Paula Vandenbark says:

    I find it interesting that groups of medical professionals believe pelvic exams are not beneficial, actually harmful to women’s health supported by scientific data while the one group, OB/GYN’s still instill that we should will have them annually!!! As this article describes, EMOTIONAL/ MENTAL HEALTH IS FAR MORE IMPORTANT! MIND-BODY-SPIRIT CONNECTION!!!!!!!!

  3. sc says:

    Well, I was having symptoms of menopause at age 50, I went to my OB/gyn after not having been to one in over 5 years and he wanted to do a pelvic sonogram in the office where he incidentally found a dermoid tumor which turned out to be benign growing on my left ovary. He immediately sent me for an MRI and I had it surgically removed a few weeks later. I had no pain from this dermoid or abdominal swelling from it and was still having periods so I was glad to find it before it had grown too large. It was an abnormal mass and it could have turned out to be ovarian cancer. Because it was on the small side I was able to have it removed laparoscopically.

  4. sc says:

    My sister went for her annual checkup and her OB/gyn found that there was a large fibroid growing in her uterus which was not causing any symptoms at the moment. The OB didn’t send her for an MRI for over 6 months, by then it had grown substantially in size, was causing symptoms and it turned out to be a malignant fibroid, a leiomyosarcoma. So having regular exams is probably a good idea, also second opinions are a good idea if the doctor blows you off. Listen to your body! My sister had only given birth the year before, it was the one year annual checkup where the abnormality was noticed. The doctor who was in another state across the country did not do the proper followup.

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  6. Lana says:

    “We need to invite women into a conversation about their health and health care” – I couldn’t possibly agree more!

    Often it feels like, when it comes to women’s health, the examinations are performed in the most practical, straightforward way, even if it causes discomfort to the patient.

    There is a joke going around that, if men could get pregnant, abortion wouldn’t even be an issue and it seems to me like it’s applicable to this topic, as well. Not a lot has been researched when it comes to women’s health and that’s a damn shame.

  7. Lynn B says:

    Over the four years I have had four pelvic exams by two different Dr. They have led to two ultrasounds one vaginal ultrasound and an endometrial biopsy. All the extra test and worry for nothing everything was normal. all four times they thought they felt something but they were wrong all four times.

    • sara says:

      In your case it was normal so you can be thankful for that. In my case, the doctor saw a cervical polyp and to rule out other inter-uterine polyps or fibroids, I had a vaginal ultrasound which happened to find a cancerous cyst on my ovary (I also had fibroids although they were not worrisome). So the over-testing was a good thing for me. I’d rather be over-tested and have peace of mind that everything is okay.

  8. Jessica Ellingson says:

    I do think however that healthy procedures for urine leakage after child birth or for what ever reason should be covered under insurance. Right now the only procedure that is covered by insurance is a very risky one that isn’t a good option for women. However because the general idea is that women shouldn’t be having sex or lose their sexual appeal after a certain age, the healthier procedure isn’t covered and women are supposed to suffer and leak urine for the rest of their lives. Why is it acceptable for most women to leak urine all day long? It is a huge feminist issue.

  9. Jen says:

    I know a friend of mine who would disagree. She wasn’t having any symptoms, but her gyn felt something concerning during a regular exam – it turned out to be early stage ovarian cancer. It was found early enough that she was able to avoid chemo and radiation, so I know she’s happy to have had that exam!

  10. Stanley says:

    Please let all women know of this great news!!! For healthy women who aren’t pregnant and don’t have symptoms, it is definitely time to put the routine pelvic exam in a deep grave for good. Gynecologists and other Doctors who disagree have very week reasons given for wanting to still perform them. If they were honest, it would probably be because of loss of money if they don’t do them and of coarse, they are human. They are human and enjoy looking at and feeling naked women. Don’t kid yourself. They chose this field for a reason.