Now You Don't Even Need a Yearly Pelvic Exam (Maybe)

After the yearly pap smear was scrapped, it was only a matter of time that they'd come for our yearly pelvic exam too. Stop it, you're putting the gynecologists out of business and making everyone upset!

The American College of Obstetricians and Gynecologists is now warring with the American College of Physicians over whether the yearly pelvic exam should be phased out. In a release Monday, ACOG said that they'd "reviewed the recommendations from the American College of Physicians about annual pelvic examinations" but found them lacking. You see, ACP claims that there's no real medical evidence that an annual pelvic exam does anything:

The College's guidelines, which were detailed in this year's Committee Opinion on the Well-Woman Visit, acknowledge that no current scientific evidence supports or refutes an annual pelvic exam for an asymptomatic, low-risk patient, instead suggesting that the decision about whether to perform a pelvic examination be a shared decision between health care provider and patient, based on her own individual needs, requests, and preferences.

But ACOG takes issue with this claim and says that gynecologists should keep doing yearly pelvic exams anyway:

However, the College continues to firmly believe in the clinical value of pelvic examinations, through which gynecologists can recognize issues such as incontinence and sexual dysfunction. While not evidence-based, the use of pelvic exams is supported by the clinical experiences of gynecologists treating their patients. Pelvic examinations also allow gynecologists to explain a patient's anatomy, reassure her of normalcy, and answer her specific questions, thus establishing open communication between patient and physician.

"Not everything we do in life can be studied in a randomized trial powered to find a scientifically valid answer one way or another," Dr. Barbara S. Levy of ACOG told the New York Times.

"I'm not sure there's evidence to support most of what we do on physical exams," she added. "Lack of evidence does not mean lack of value."

The pelvic exam in question involves use of the speculum to inspect the vagina and cervix, visual examination of the outer genitalia and "bimanual examination" aka that part when they put their fingers inside of you and poke around to see that your uterus etc. feels alright.

The American College of Physicians, however, has found that these steps can be uncomfortable for women, particularly women who have experienced sexual trauma in their past. They also claim that the exams can result in misdiagnosis and unnecessary medical costs for women. Instead, they recommend exams only for women who have symptoms indicating something might be wrong with them, not "asymptomatic, nonpregnant, adult women" who always get everything good taken away from them.

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