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Pelvic Exam: One More Thing Women Can Skip?


It seems as if the annual health to-do list for women over 50 is getting shorter and shorter.

All those routine tests we thought we needed every year to stay on top of things - like mammograms and Pap smears - experts now say are really unnecessary. The latest thing we should cross off the list: a yearly pelvic exam.

A new study from the University of California, San Francisco (UCSF), says a pelvic exam, in which the physician inserts one hand inside the vagina and uses the other to feel the uterus and ovaries, "frequently is performed for reasons that are medically unjustified." The study was published online in the American Journal of Obstetrics and Gynecology.

Researchers, who surveyed 521 physicians, found that doctors were ignoring new guidelines and still regularly conducting the exams on women who have no other risk factors and no symptoms of any problems. For example, most of the doctors said they would perform the exam on a 55-year-old woman with no ovaries, uterus or cervix - and more than half considered such an exam to be very important for that woman.

Nearly half the physicians believed the exam was very important in screening for ovarian cancer, despite evidence that it's ineffective at detecting stage I tumors. As for detecting postmenopausal changes, a visual exam of the tissues would be just as useful - and less uncomfortable and invasive.

A similar finding was reported last year in a larger study by the Centers for Disease Control and Prevention. The CDC study, which surveyed 1,250 physicians, also showed that the majority use a pelvic exam to screen for sexually transmitted diseases, even though a simple swab or urine test is enough.

And why are doctors conducting these exams? Both the UCSF and the CDC studies say it's because women expect it. (Sure, blame the patient when who's been telling us for decades that we need to have this done every year?)

And -oh, yeah - doctors also do the exam because "it ensures adequate compensation for routine gynecologic care," UCSF researchers reported. Meaning, doctors might not get reimbursed as much from insurers without doing the exam.

Plus, the researchers found some regional differences: Doctors in the Northeast and the South were more likely to consider the exams very important and to believe they "reassure patients of their health.''

What this all means is that older women with no risk factors or suspicious symptoms, like pain or bleeding, might want to have a conversation with their doctor about whether a yearly pelvic exam - and we all know how uncomfortable that is - is really necessary.











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