There is a hidden battle brewing within the medical community about the misuse of  physicians’ valuable time.  Three female Doctors have come together to write a compelling journal article showing how the significant amount of time physicians spend conducting pelvic exams on asymptomatic women is unjustified.  Doctors Westhoff, Jones, & Guiahi (2011) state “Overuse of the pelvic examination contributes to high healthcare costs without any compensatory health benefits“.

Physicians use four justifications for conducting pelvic examinations, but Westhoff, et al. (2011) reveal how the justifications are no longer relevant in light of current research, advancements in technology, and new guidelines put in place to reduce harms of over screening for cervical cancer.  The four justifications used by physicians to conduct pelvic exams on asymptomatic women, together with the counter-arguments against them by the research authors, can be summarized as follows:

• Justification #1: Screening for cervical cancer.

Counter-argument:  The authors state that new guidelines recommend less frequent screening, and that women “may prefer less frequent testing for its own sake and will also benefit from fewer false positive results; thus, they will also experience fewer consequent diagnostic and treatment procedures”.  In addition, HPV testing is more accurate than Pap testing, and a specimen can be obtained using a self administered vaginal swab.  There is also an accurate self-lavage system used by women in the Netherlands that does away with the need for a speculum exam, but this has been made unavailable to women in other Countries.

• Justification #2: Provision of contraception.

Counter Argument:  The authors discuss how no findings from a pelvic exam would change the decision to prescribe contraception, and that “guidelines from the U.S. FDA, World Health Organization, College of Obstetricians and Gynecologists, and others explicitly specify that a pelvic examination is not required in an asymptomatic woman for the initiation of systemic hormonal contraceptives”.

• Justification #3: For sexually transmitted disease screening.

Counter-argument: The authors outline how blood/urine are all that is required to test for sexually transmitted diseases.  No pelvic exam is necessary.

• Justification #4: Detection of ovarian cancer.

Counter-argument:  The speculum exam is routinely accompanied by a bimanual exam (two fingers inserted into the vagina with palpation of uterus and ovaries) in hopes of detecting ovarian cancer.  The authors state this exam “has poor specificity”, and that “data determined that no ovarian cancers had been detected with this modality”.  The authors further argue that a bimanual exam is entirely unnecessary in asymptomatic women.

The authors conclude the article by stating that “it is time to get asymptomatic women off the table”.  This would help to free up valuable time for physicians to address women’s real health concerns, and it would also please many women.

Link to article: jwh.2010.2349 (application/pdf Object).