Unnecessary pelvic exams and pap tests in teens

A news article by Judith Orvos, ELS in the Feb 2020 issue of Contemporary OB/GYN highlighted a study published in JAMA addressing this concern.

This study analyzed data from the National Survey of Family Growth (NSFG) between 2011 - 2017 in which 3410 women aged 15 to 20 years in the United States were asked

• whether they had a bimanual pelvic exam (BPE) in the past 12 months -"where a doctor or nurse puts one hand in the vagina and the other on the abdomen?”
• and whether they had a pap test in the past 12 months "where a doctor or nurse put an instrument in the vagina and took a sample to check for abnormal cells that could turn into cervical cancer?"

A bimanual pelvic examination (BPE) is used to evaluate a woman's internal pelvic organs and the value of a routine pelvic exam has recently been questioned.

1. More than half of the 22.9% of young women aged 15 - 20 who received a BPE in the past 12 months were potentially unnecessary. This was estimated at 1.4 million individuals nationally.
2. 19% of women aged 15 - 20 years received a pap test and 71% of those were performed as part of a routine examination estimated at 1.6 million women in the US.

ACOG Committee Opinion Number 754: The Utility of and Indications for Routine Pelvic Examination recommends that pelvic examinations be performed when indicated by medical history or symptoms like pelvic pain or bleeding.

Unnecessary pelvic exams and pap tests can cause harm. It can result in anxiety and fear unnecessary treatment and excessive costs.

Clinicians should be aware that linking a pelvic examination or pap test to hormonal contraception or STI screening is no longer required.

The authors of this study conclude that "the need for education for health care professionals, parents, and young women themselves to improve awareness of professional guidelines..."

References:

1. Contemporary OB/GYN February2020 Vol 65 No.2: p16
2. Qin J, Saraiya M, Martinez G, Sawaya GF. Prevalence of potentially unneces-sary bimanual pelvic examinations and papanicolaou tests among adolescent girls and young women aged 15-20 years in the United States. JAMA Intern Med. June 2020. doi:10.1001/jamainternmed.2019.5727
3. ACOG Committee Opinion Number 754 : The Utility of and Indications for Routine Pelvic Examination
4. Screening for Gynecologic Conditions With Pelvic Examination US Preventive Services Task Force Recommendation Statement. JAMA. 2017;317(9):947-953.