In an interview, Westhoff said that doctors routinely find a lot of unimportant conditions and then “start ordering tests or more frequent exams” or surgery, which carries a risk of complications for things that don’t need treatment. “If a woman is asymptomatic, we should leave well enough alone.”
But, Westhoff noted, the exam inspires fierce loyalty for reasons both cultural and financial. “A pelvic is deeply embedded in what it means to be an OB-GYN. People who go into obstetrics are very action-oriented, very procedure-oriented,” she said. “As a clinician myself, it was hard to stop doing it.” Many gynecologists, she added, are “not going to get paid if [they] don’t do a pelvic” because insurance reimbursement is largely predicated on procedures.
Westhoff said that some of her colleagues, only half in jest, have asked, “Carolyn, are you trying to put us all out of business?” Without the need for an annual pelvic exam or Pap test, some women without symptoms, particularly those who also see an internist or family physician, may skip their annual visit to the gynecologist.
To Cynthia Pearson, the executive director of the National Women’s Health Network, a Washington-based advocacy group, the pelvic exam consumes time that could be better spent screening for sexually transmitted diseases or discussing important issues such as blood pressure or diet. “It isn’t an essential part of a well-woman exam,” Pearson said, “nor does it help women stay healthy.”
Internist Sandra Adamson Fryhofer, a past president of the American College of Physicians, tells patients the choice is theirs. “For something that’s uncomfortable and anxiety-provoking, it’s only fair for women to know what the evidence shows,” said Fryhofer, who practices in Atlanta. Half of her patients request a pelvic exam, which “takes less time than discussing it.”
At Kaiser Permanente in San Francisco, gynecologists abandoned routine pelvic exams about a decade ago, after internal studies found little benefit.
“Now that we do cervical-cancer screening every three years, we leave [a decision about the pelvic exam] up to the patient, and we certainly want to see them every three years,” said Steven J. Masters, the chief of obstetrics and gynecology at Kaiser. Masters said he considers the value of the pelvic exam to be “absolutely nil,” but he performs the exam if a patient requests it. Most of his patients, he said, are “delighted” to skip it. “This isn’t about saving money at all, but about doing things based on outcomes rather than habit.”
But ACOG’s Levy said she believes the pelvic exam “opens the door and is a time of intimacy between the patient and care provider,” encouraging patients to discuss sexual concerns, urinary incontinence, and other issues they might otherwise avoid.
Norsigian of Our Bodies Ourselves said it behooves consumers to make an informed choice. “Women should not be bullied by their doctors” into having an exam, but should make the decision that best suits their circumstances, she said. “Medicine is often slow to change, particularly in this field.”
This article appears courtesy of Kaiser Health News.