A woman expresses surprise at the contents of a pelvic exam tray.
Leeches used to be used as a medical cure-all, but today are of course almost entirely discredited. It s worth wondering how many other medical tests from the prostate-specific antigen to routine mammography will one day be relegated to the dust bin of history. The latest exam to undergo scrutiny are routine pelvic exams for women, which the New York Times reports may be doing more harm than good.
At issue is something called a bimanual exam an embarrassing manual check of the uterus and ovaries, often done as a matter of course as part of a gynecological exam.
Some 63.4 million pelvic exams were performed in U.S. physicians offices and clinics in 2008, according to an article in JAMA last December criticizing the practice.
Pelvic examinations have been performed on asymptomatic women to screen for sexually transmitted infections, to screen for ovarian and other gynecologic cancers, and to determine whether women should receive hormonal contraceptives, wrote Dr. Mona Saraiya, MD, Ph.D., of the CDC. However, use of pelvic examinations for these purposes is not supported by scientific evidence and is not recommended by any U.S. organization.
Dr. George Sawaya, a professor of obstetrics at the University of California, San Francisco, told the Times that he d frequently have to take patients into the operating room because he d find an enlargement during a bimanual exam.
I then follow up with a sonogram which shows a mass, but I can t tell what the mass is without surgical exploration. Yet nearly always it s benign, says Dr. Sawaya, criticizing doctors who put patients in a perilous situation and then act like they re rescuing them.
Dr. Carolyn Westhoff, a gynecologist at Columbia University Medical Center, is also critical of the routine exams, writing in the Journal of Women s Health in 2010 that they do not lead to earlier detection of cervical cancer and are not as effective as self-administered vaginal swabs or urine in detecting sexually transmitted diseases. Speculum and bimanual examinations are uncomfortable, disliked by many women, and use scarce time during a well woman visit, she wrote.
Whenever doctors are doing things by rote, we have to rethink whether what they re doing is really helpful, Dr. Sawaya told the Times. Amen to that.
