Millions undergo unnecessary pelvic exams in US: Research

More than half of the bimanual pelvic examinations performed over a seven-year period on a cohort of more than 2.5 million young women in the US were potentially unnecessary. 
 
Those are the findings of new research in JAMA Internal Medicine.
 
The population-based cross-sectional study used data from 3410 women aged 15–20 between 2011 and 2017. The researchers classified pelvic examinations into two types: medically indicated, or potentially unnecessary.
 
Examinations were considered medically indicated if performed during pregnancy, associated with the use of an intrauterine device, or in the context of treatment for a sexually transmitted disease.
 
The researchers estimated that, of the 2.6 million young women who received a pelvic exam during the previous year, more than half (54.4%) were potentially unnecessary.
 
That represents an estimated 1.4 million young women.
 
RACGP spokesperson and cervical cancer screening expert, Dr Lara Roeske, told newsGP the results astounded her but she does not believe these data represent Australian practice.
 
‘When we’re talking about the Australian general practice system and the American primary care system, we’re comparing apples with oranges,’ she said.
 
‘I’m pleased to say that the data tell us that doesn’t seem to be the case in Australia.’
 
Dr Roeske said standards are in place here to ensure pelvic examinations only occur when clinically appropriate.
 
‘There are clear clinical reasons when a pelvic examination should occur,’ she said.
 
These can usually be ascertained during the history taking part of the consultation, Dr Roeske said.
 
‘The RACGP certainly has a set of standards and recommendations around how [internal pelvic examinations] should be conducted,’ she said.
 
‘Obviously it is a sensitive examination that requires an appropriate approach and technique.’
 
The researchers also found nearly one fifth of females younger than the recommended age in the US had a Pap test within the past year.
 
Dr Roeske said that the current cervical screening program in Australia only requires women to engage in cervical cancer screening from the age of 25.
 
She also said internal pelvic examinations were no longer considered appropriate to routinely perform at the time of a cervical screening test.
 
‘In terms of cervical screening – certainly with this current national screening program in Australia, also with the previous program – the pelvic examination has been deemed not appropriate, not evidence-based, [and] should not be happening at the same time,’ she said.
 
She said Australia has ‘a very robust’ cervical screening program which has been in place since the early 1990s.
 
‘We have well-researched and high-quality evidence [showing] Australian GPs have actually been a shining light in getting women to participate in this program … when they’re age-eligible,’ she said.
 
‘So what we find is GPs are very comfortable with national guidelines, they actually adopt them.
 
‘Also, our GPs have been aware of the change to the requirement of an internal pelvic examination as part of cervical screening, which has been present now for at least a decade and a half. That was part of the previous screening program.
 
‘I do believe that Australian GPs are undertaking internal pelvic examinations judiciously, particularly in these younger women, and only when really it is medically necessary.’
 
Dr Roeske said there are a number of reasons young women present to their GP to discuss sexual health related issues.
 
‘[These include] discussions around safe sex, contraception, avoiding an unwanted pregnancy, understanding the role and how to access emergency contraception, understanding the role of alcohol and drugs and the ability to navigate safe sex and respectful sex, also discussing the risk of sexually transmitted infections,’ she said.
 
‘None of those things would require an internal pelvic examination.’

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