Many young women get unnecessary pelvic exams

[January 07, 2020]  By Lisa Rapaport

(Reuters Health) - Although guidelines say most women under age 21 don't need pelvic exams or cervical cancer screenings, a U.S. study suggests many still get these invasive tests.

Nationwide, an estimated 1.4 million such women get potentially unnecessary pelvic exams and an estimated 1.6 million get cervical cancer screenings they may not need, researchers report in JAMA Internal Medicine.

Needless tests "can lead to false alarms, unnecessary treatment, and needless cost," said study leader Jin Qin of the U.S. Centers for Disease Control and Prevention in Atlanta.

"Many young women associate the examination with fear, anxiety, embarrassment, discomfort and pain," and some of them "may forgo contraception or sexually transmitted infection (STI) screening because of psychological stress associated with these exams, which could lead to unintended pregnancies and may increase overall health risks, "Qin said by email.

Cervical cancer screening, done by placing an instrument into the vagina to scrape cells from the cervix, isn't recommended for women under 21 under guidelines from the U.S. Preventive Services Task Force, the American College of Obstetricians and Gynecologists and the American Cancer Society.

Pelvic exams, which typically involve inserting a speculum to widen the vagina and visually examine the cervix as well as a manual internal exam of the reproductive organs and rectum, aren't recommended for asymptomatic women who aren't pregnant.

Young women and parents of teens should know that prescribing most contraceptives and testing for many STIs doesn't require pelvic exams or cervical cancer screening, the researchers note.

For the study, they examined national survey data collected from 3,410 women ages 15 to 20 between 2011 and 2017.

About 23% women reported having a manual internal pelvic exam in the previous year, translating into approximately 2.6 million young women nationwide.

More than half of these pelvic exams - about 54% - did not appear to have medical reasons like pregnancy, STI symptoms or use of an intrauterine contraceptive device (IUD). This means approximately 1.4 million teens and young women may have had unnecessary exams.

In addition, about 19% of the women said they had cervical cancer screening with a Pap test in the previous year, translating into 2.2 million nationwide. Pap tests are only recommended for a small minority of women under 21 who are HIV-positive and sexually active, suggesting most of these tests were also unnecessary.

"Recommendations and guidelines have evolved over time," Qin noted. "Prior to 2012, guidelines recommended starting cervical cancer screening at or around onset of sexual activity or age 21, whichever came first. In 2012, recommendations from major organizations agreed that the initiation age (should) be 21 years regardless of sexual behaviors and risk factors. Leading professional organizations have issued or updated their recommendations regarding pelvic examination since 2014, recommending against pelvic examination among women who are not pregnant or have no symptoms."

However, she added, "many healthcare professionals still believe that the pelvic examination is a useful tool to screen for gynecologic cancers, contrary to guideline recommendations."

Even when women don't think they need pelvic exams or Pap tests, they should still get annual checkups, said Dr. Melissa Simon of the Northwestern University Feinberg School of Medicine in Chicago, who wrote a commentary accompanying the study.

Women should ask questions before consenting to these tests and consider switching providers if they're told they can't get birth control without a pelvic exam, Simon said by email.

"In the absence of any symptoms or other diseases such as being immunocompromised - like having HIV, AIDS or cancer) - a pap test is not needed prior to age 21," Simon said.

"Also, a pelvic exam is not needed," Simon added. "And, neither a pelvic exam nor a pap test is needed in order to obtain contraception, except in the case (of) an IUD."

SOURCE: https://bit.ly/2FrZia6 and https://bit.ly/39IyrEl JAMA Internal Medicine, online January 6, 2019.

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