Pelvic exams are currently up for review by the US Services Preventive Services Task Force. The task force reviews scientific evidence to determine the effects of preventive services, such as screening tests for cancer. The task force makes recommendations based on the evidence, and provides guidelines to physicians and other health care providers.
The task force is poised to make recommendations regarding whether or not the pelvic exam should continue to be performed routinely on asymptomatic, non pregnant women. As part of their review, the task force is seeking input from the public until July 25.
Now is the time for women to have their say. The task force tallies the harms and benefits when conducting reviews, but women’s experiences and voices seem to be largely unrepresented in decisions about what happens to them in health care settings. The human cost of pelvic exams for some women is significant. To learn that there is a lack of evidence in relation to the benefits of having the exam is devastating.
Two years ago the American College of Physicians (ACP) recommended against performing pelvic examinations in asymptomatic, nonpregnant, adult women based on a systematic review of the literature from 1946 through January 2014. The review found no benefits to performing pelvic exams. The authors of the review concluded that “screening pelvic examination exposes women to unnecessary and avoidable harms with no benefit (reduced mortality or morbidity rates)”http://annals.org/article.aspx?articleid=1884537
The task force has disclosed “that the current evidence is insufficient to assess the balance of benefits and harms” and that the “evidence is lacking and of poor quality, and the balance of benefits and harms cannot be determined” http://www.uspreventiveservicestaskforce.org/Page/Document/draft-recommendation-statement157/gynecological-conditions-screening-with-the-pelvic-examination
The psychological harms of pelvic exams have not been sufficiently studied. The task force states “No studies quantified the amount of anxiety associated with screening pelvic examinations”. Unfortunately, anecdotal evidence and qualitative studies may not be recognized in the task force’s review. For example, this study http://www.tandfonline.com/doi/abs/10.1080/02646839308403222?journalCode=cjri20& describes how gynecological procedure can cause PTSD that is comparable to post-war veteran’s experiences of PTSD, yet the results of this study may not be considered in the task force’s review.
The toll on women is evident in the study. Some of the phrases used by the women who took part in the study to describe their experiences include:
-‘dehumanizing and painful’;
-‘degrading and distressing’;
-‘my opinions were dismissed as irrelevant’;
-‘hurting and feeling violated’;
-‘very brutal internal was excruciating’;
-‘it felt undeniably like rape’. https://forwomenseyesonly.com/2015/01/10/gynecological-procedures-can-cause-ptsd/
The physical harms as a result of pelvic exams have also not been sufficiently studied. For example, false-positives that may lead to over treatment such as unnecessary removal of the ovaries has not been quantified.
Women now have an opportunity to have their voices heard and hopefully to be given the same consideration as those of vested interests. The task force’s decision on recommendations can make the difference between these exams continuing – or not. Given the lack of evidence to support the efficacy of the exam, and the harms experienced by many women, the choice to discontinue the exam seems clear. If the task force does not recommend discontinuing the exam then at the very least doctors need to start disclosing the lack of evidence to their female patients, and to ask for consent prior to going ahead with the exam. Women have the right to know that the exam “exposes women to unnecessary and avoidable harms with no benefit” http://annals.org/article.aspx?articleid=1884537