Battle Brewing Over Pointless Pelvic Exams

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).


  1. Sue, brilliant article. I hope and pray that this is made available for everyone (especially women) to read. Not put in some out of the way, out of reach medical journal. This needs to be publicized as widely as all the pro pap crap is. Thanks so much for putting this up!

  2. Reblogged this on A VOICE FOR HOPE and commented:
    Women who have been sexually abused and or raped often struggle with having pelvic exams performed on them even decades after the trauma. Here is a great post they can print out and take to the healthcare provider showing a pelvic exam is often NOT justified.

    • Thanks for this. It is a great idea to print the article and take it along to give the dr. And even for women with no history of sexual abuse it is a good idea. I plan to print out the original journal article and take it with me next time I need to go to a walk in clinic. If I start getting pressured into a pelvic exam, after I have already said no to one, I plan to give the article to the dr.

    • Also I’d an SA survivor is choosing a pelvic exam, they’re not necessarily consenting to it and so it’s SA all over again.

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