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Charlotte doctors object to guideline for annual pelvic exams

Most women who see an obstetrician-gynecologist every year are used to having a pelvic exam.

But the benefits of that screening test were called into question earlier this year when the American College of Physicians concluded it’s unnecessary for women who do not have cancer symptoms and who are not pregnant.

The guideline published in the Annals of Internal Medicine concluded manual pelvic exams do not detect disease as well as previously thought, do not reduce mortality, and may result in unnecessary testing and anxiety for women.

The backlash was immediate from OB/GYNs.

The American College of Obstetricians and Gynecologists reaffirmed its support for annual pelvic exams for women over 21. And doctors from Novant Health Bradford Clinic, Charlotte’s oldest OB/GYN clinic, issued a news release outlining objections.

“This is a giant step backwards,” said Dr. Scott Schneider. “Those of us that do them feel this is a very important part of a woman’s health assessment.”

Schneider criticized the ACP – an organization of internal medicine doctors, not gynecologists – for not taking into account the indirect benefits of a pelvic exam. He said it can reveal malignant or pre-malignant lesions the patient is unaware of or may be embarrassed to talk about. Without such an exam, Schneider asked, “How is she going to find a pre-malignant lesion on the vulva?”

Schneider and his colleagues worry that confusion about what is recommended could cause women not to see their gynecologists regularly. “For many women, the gynecologist is their only primary care physician,” he said.

Dr. Richard Wender, the American Cancer Society’s chief cancer control officer, said that group hasn’t recommended annual pelvic exams for 10 years because the benefits do not outweigh the potential harm.

Certainly, some women have benefited from finding a malignancy and having it removed. But that circumstance is so rare, Wender said, it’s “impossible to show benefit across a population.” Harm is also infrequent, but “some women do experience significant discomfort ... (and) needless anxiety.”

False positives can lead to unnecessary tests, procedures and office visits, adding unnecessary cost, the ACP guideline said.

The new guideline has nothing to do with Pap smears. Those tests are recommended every three years starting at age 21. At 30, if previous tests have been negative, the recommendation is for every five years, combined with a test for human papillomavirus.

The ACP guideline does say a pelvic exam is appropriate for women with symptoms such as vaginal discharge, abnormal bleeding, pain, urinary problems or sexual dysfunction.

As always, patients should talk with their doctors. It’s OK to continue annual exams, while understanding the cost and potential harm. But it’s also OK to say no.

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