Is this trip to the gyno actually a waste of time?

You know that moment when you’re at the gynaecologist, or the GP, and your pap smear is over, and your pelvic exam begins?

The doctor generally feels around your belly and pelvic area while also having their fingers inside you. It’s generally uncomfortable (as is the entire pap smear process), and occasionally even unpleasant. But like so many other things in life, it’s something women put up with because we know that it’s good for our health.

Except… it might not be so good for our health after all. In fact, pelvic exams have been making headlines for some time now, with various studies suggesting that the entire exam process is actually relatively useless.

And last week, the American College of Physicians – America’s largest medical-specialty organisation – released new guidelines that give a “strong recommendation” against performing pelvic examinations on women who are not pregnant and have no symptoms.

The ACP reviewed published literature from 1946 through to 2014 to determine just how useful the pelvic exam is when screening for pathology. They examined accuracy of the screening pelvic examination in detecting cancer, pelvic inflammatory disease and other gynecologic conditions. They also examined issues relating to overdiagnosis and overtreatment, with false positives being very common.

The result? The “diagnostic accuracy of the pelvic examination” was very low – in other words, it did little to detect any problems.

96.7% to 100% of abnormal pelvic examinations did not identify ovarian cancer, and there was no

reduction in cancer mortality rates that could be associated with the pelvic examination.

However, significant harms were found through the study – including “fear, anxiety, embarrassment, pain, discomfort and urinary tract infections and symptoms, such as dysuria and frequent urination.” 10% to 80% of women who experienced a pelvic exam reported feeling fear, embarrassment, or anxiety, and some even experienced pain – as a result, they were less likely to return for another exam.

Anyone who’s ever had a pelvic exam is probably nodding their head at this point. In the realm of pleasant-to-unpleasant experiences, pelvic exams (and the generally accompanying pap smear) rate somewhere between dodgy Brazilians and stepping on itty-bitty pieces of Lego.

So right now, you might be pretty excited at the news that the ACP deemed pelvic exams to be useless and unnecessary, as the “

harms outweigh any demonstrated benefits associated with the screening pelvic examination.”

However – it’s not time to go cancelling your next gynaecological appointment just yet. In fact it is never time to cancel that appointment – it’s important y’all.

There has been significant debate around the issue of pelvic examinations, and not all organisations or practitioners agree with the recommendations of the ACP. In fact, the American College of Gynecologists released a statement last week that they had reviewed the recommendations, but continue to stand by their own guidelines:

Confused now? Yes, me too. So I asked

Dr

Martin Ritossa, a Spokesperson from the

Royal Australian and New Zealand College of Obstetricians and Gynaecologists, about the official Australian recommendations in regards to pelvic examinations.

Martin

So, in conclusion?

Don’t get your hopes up about skipping the pelvic exam altogether – the doubt is still there. And while no one has reached any hard and fast conclusions about the pelvic exam, it makes sense that it should continue to be part of the regular check-up process for women visiting their doctor for the process every two years.