The annual pelvic exam is uncomfortable, invasive — and might not be necessary for healthy women. Or is it?
There isn't a clear answer. An influential government task force determined Tuesday there isn’t enough solid science to prove that the exams are needed and there also isn’t enough to recommend discontinuing them.
“For asymptomatic women, we are not recommending for or against,” Dr. Kirsten Bibbins-Domingo, chair of the U. S. Preventative Services Task Force and a professor of medicine at the University of California, San Francisco told TODAY. “We’re issuing a call to researchers to provide us with more information.”
The USPSTF is an independent, volunteer panel of national experts who make preventive health care recommendations based on evidence from all available scientific studies.
Right now, "there isn’t any good evidence supporting the value of the annual pelvic exam in women with no symptoms," Bibbins-Domingo said. "We think women should be aware of that and talk to their doctors about whether the annual exam is right for them.”
A pelvic exam involves a doctor or nurse practitioner inserting the gloved finger of one hand into a woman's vagina, while the other hand presses down on her abdomen. The object of the exam is to get a feel for the health of the woman's reproductive organs, including their size and position in the abdomen.
Why you may not need a yearly pelvic exam
The task force report comes as a growing number of medical experts suggest annual pelvic exams are unnecessary for women who don't have symptoms.
Some doctors believe pelvic exams can help detect ovarian cancer in its early stages. Others, such as Dr. Jennifer Potter, director of the Women's Health Center at Beth Israel Deaconess Medical Center and an associate professor of medicine at the Harvard Medical School, say there's no data proving the exam has value detecting ovarian cancer when done in women who are asymptomatic.
Potter argued against routine pelvic exams in an article in the Annals of Internal Medicine last year.
A pelvic exam can detect uterine tumors, but this type of cancer usually causes symptoms, such as heavy bleeding, Potter told TODAY earlier.
Beyond the discomfort caused by the exam, there are other downsides: When doctors believe something feels amiss, women may get further diagnostics, including potentially unneeded surgeries.
Why a yearly pelvic exam helps
The American College of Obstetrics & Gynecology guidelines advise against annual Papanicolaou tests— Pap smears — which are used to diagnose cervical cancer. But the gynecologists' group does recommend annual pelvic exams to screen for other health issues, including ovarian cancer.
Even if the exam isn't always useful to screen for ovarian cancer, it can tell a doctor about a number of other conditions, Dr. Hope Ricciotti, the chair of obstetrics and gynecology at Beth Israel Deaconess argued in the 2015 journal article on pelvic exams.
Ricciotti told TODAY a pelvic exam can:
Detect that a woman's uterus is starting to prolapse
That means the muscles holding the uterus in place have weakened and it is slipping out of place and down towards the vagina. This can happen after pregnancies, so it can affect both younger and older women.
Help diagnose endometriosis
If a woman's organs seem stuck together that could be a sign of endometriosis. A pelvic exam might prompt a doctor to ask whether the woman is having pain during intercourse.
Be a teaching moment for younger women
Women don't always know what is normal and what is abnormal, Ricciotti said, so they may not complain about symptoms. And "women can be too embarrassed to ask about some of those things," she said.
But is yearly necessary?
"We've got to find some middle ground here," Riciotti said.
Dr. Priya Batra may have found a middle ground.
"In my practice I do tell the patients, if they don't have any symptoms and aren't pregnant, that it's unclear whether we get a lot of information from the routine pelvic exam," said Batra, an ob-gyn at the University of California, Los Angeles, Medical Center. "From my perspective, it can be offered, but it's not necessarily a requirement."
While the jury is still out on the value of annual pelvic exams in asymptomatic women, "we believe that women should see an ob-gyn for well-woman care once a year," Dr. John Fisch, director of Womancare Associates and an associate clinical professor in the department of obstetrics and gynecology at Magee-Women's Hospital of the University of Pittsburgh Medical Center told TODAY.
"At that point we can talk about whether a pelvic exam is appropriate. It's something that has to be individualized," said Fisch.