Do You Really Need that Embarrassing and Uncomfortable Pelvic Exam?
In her New York Times column on Personal Health, Jane Brody recently questioned the value of routine pelvic exams during visits to the gynecologist. (Routine pelvic exams during labor are also questionable, but that is for another post.) Women get a pelvic exam just about every time they see their OB/Gyn; that adds up to about 63.4 million pelvic exams a year in the U.S. Women rarely question the need for the pelvic exam; they just accept it as necessary since it is so universally practiced in this country. Providers don’t question it, either; they just do it. In an interview with Brody, Dr. Carolyn L. Westhoff, a gynecologist at Columbia University Medical Center, said “This is not the case in other countries that get better results without doing routine pelvic exams.”
The recommendations for a Pap smear have been reduced from yearly for all women to every three to five years for most women and never for older women. Screening for sexually-transmitted infections can be done without an invasive pelvic exam, using a urine sample or a vaginal swab that the woman can do herself. Studies have shown that pelvic exams do not find asymptomatic ovarian cancer, eliminating another justification.
Of course, there are situations in which a pelvic exam is needed, but rarely during a routine visit. If a woman has pelvic pain, heavy bleeding or no bleeding, abdominal bloating or tenderness, a pelvic exam can be a first step in diagnosing her problem It is almost always just a first step, however, followed by imaging (sonogram, etc) and other diagnostic studies.
One important reason for all those pelvic exams remains – the added charge can increase compensation for the visit considerably. Pelvic exams are a procedure, albeit a minor one, and procedures always trump interactions such as listening to women’s complaints, giving advice or education, and so forth when it comes to billing.
To read Brody’s article, go to http://well.blogs.nytimes.com/2013/04/29/an-exam-with-poor-results/?src=xps.