Is It Necessary?

The US Preventive Services Task Force (USPSTF) has conducted a systematic review of the literature to answer 3 questions about routine pelvic exams in otherwise asymptomatic females: (please note that pelvic exam isn't the same as pap smear):1. Do pelvic exam reduce the morbidity, mortality and/or improve

1. Do pelvic exam reduce the morbidity, mortality and/or improve quality of life?
2. How well do pelvic exams screen for GYN cancers or other gynecologic conditions?
3.Are there adverse effects of screening for GYN conditions using pelvic examination?

This was the first time such a review had been performed.

Their conclusion was that there was no direct evidence on the overall benefit or harm of the pelvic exam as an one time or periodic screening test. This draft was made public on June 28, 2016. And is currently open for comments from the public.

This conclusion is very disruptive for the status quo in clinical practice for both patients and OBGYNs. The American College of Obstetricians and Gynecologist issued a statement that same day saying that it would review the evidence and assess if there is a need to update their guidelines on routine pelvic examination

My opinion as an OBGYN:
There is little benefit to a GYN exam in a woman with any gynecologic complaints.

Preventive screening tests for STI's and ordering of mammograms and bone density screening can easily be done in a woman's PCP office. Recommendations of cervical cancer screening (PAP smears) have changed to every 3-5 years dependent on whether high risk HPV was done. None of the recommended screening necessarily needs to be done by an OBGYN

So why do women need OBGYNs?:
OBGYNs are specialists in female healthcare. Just as we see a cardiologist when we have a heart condition or heart problem; women should see an OBGYN when they have a female condition or a female problem ie contraception, pregnancy, abnormal bleeding, menopause. This is not dismissive of female health care, rather this allows OBGYNs to diagnose, manage and treat many female issues that affect women which is what they were trained to do.

Author
Sharan Abdul-Rahman, MD

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