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To Examine or Not to Examine? That is the Question

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There’s a curve ball currently being thrown at a decades-long practice in women’s health. The American College of Physicians (ACP) released new evidence-based guidelines this month recommending against routine pelvic exams in adult, asymptomatic, non-pregnant women at average risk for cancer (July 1, Annals of Internal Medicine). The authors, who did a systematic review of 68 years’ worth of published literature, state that the “harms of screening pelvic examination outweigh any demonstrated benefits” – more specifically that pelvic exams “rarely detect important diseases or reduce mortality,” and can cause “pain, discomfort, fear, anxiety, or embarrassment” in women.

The authors also state that routine pelvic exams “lead to unnecessary, invasive, and potentially harmful diagnostic procedures,” driving up health care costs. That’s no small matter, considering that, preventive gynecologic services cost the U.S. health care system an estimated $2.6 billion each year, according to the ACP.

“The gynecological exam, or ‘well-woman exam,’ is an annual opportunity for women to pursue issues relating to their reproductive health, sexual function, and pelvic anatomy,” said Peter Gearhart, MD, of Penn Ob/Gyn & Midwifery Care at Pennsylvania Hospital.

“It is a forum for patient-physician discussions relating to everything from health education, contraceptive counseling, and pelvic organ function, to screening for sexually-transmitted infections and urinary incontinence. This isn’t the first time guidelines have been altered, and I’m sure it won’t be the last.”

Read more about this issue by visiting the Penn Medicine News Blog here.

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