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Most Women Don't Need Regular Pelvic Exams: ACP

Review found no evidence they benefit many women, but cervical cancer screening still needed

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"The reasoning behind why clinicians are doing it has never been very clear," said Dr. George Sawaya, a professor of obstetrics, gynecology and reproductive sciences at the University of California, San Francisco.

Instead, the pelvic exam is more like a "ritual" than an evidence-based practice, said Sawaya, who cowrote an editorial published with the new guidelines in the July 1 issue of the Annals of Internal Medicine.

The reason women have the exam yearly is because it has been traditionally coupled with Pap testing for cervical cancer, Sawaya noted. However, experts no longer recommend annual Pap tests, and instead say women at average risk of cervical cancer can have them every three years, starting at age 21.

Humphrey added that if women want to be screened for a sexually transmitted disease, like gonorrhea or chlamydia, that can be done with a urine test or vaginal swab instead of a pelvic exam.

The ACP represents U.S. internists, but many women get their pelvic exams from gynecologists -- who have their own professional guidelines, last updated in 2012.

Those guidelines, from the American College of Obstetricians and Gynecologists (ACOG), are much less direct: On one hand, ACOG says all women age 21 and older should have an annual pelvic exam. But the guidelines go on to acknowledge that "no evidence supports or refutes" the annual screening exam -- and that the decision is ultimately up to women and their doctors.

A spokesperson for ACOG said the group did not want to make a "blanket statement" against an exam that might benefit "a lot of women." And in a written statement, ACOG said its guidelines "complement" the new ones from the ACP.

According to Sawaya, the ACP research review does leave questions open. For one, none of the studies looked at the accuracy of pelvic exams in screening for noncancerous growths.

So, Sawaya writes in the editorial, it's "reasonable" to disagree with the ACP's advice.

But he said it's also reasonable for women to ask their doctor whether a routine pelvic exam is necessary, and to ask for more information on the possible benefits and risks.

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