Pelvic Exam – Is It Necessary to be Done Routinely?

From all the ignominy that females go through in their lifetime, the regular pelvic exam is definitely among the highly feared ones.

Several females find it humiliating, mortifying, invasively-done procedure & also agonizing for many. The most aggravating part of it all is the constant instruction to be relaxed which actually has the contrary effect.

Presently, a confrontational case has been put forth in the Jan edition of the Journal of Women’s Health that states that among females in good health and not symptomatic due to any condition, a habitually conducted pelvic exam would serve hardly any use – & might be abhorred to such an extent that it deters several females from undergoing usual gynaecologic care.

According to C. Westhoff, Prof. of  Obst. & Gynaecology from Columbia Univ. Medical Center who also helmed the trial, non-symptomatic females who feel alright, but yet have to unclothe on exam tables having stirrup & speculums does in no way add any further value. She believes that doctors must instead discuss dietetic intake, exercising & inoculations with these women – giving time to them for listening to the reasons for their worry. Westhoff feels that something which is discomforting, mortifying & not so beneficial could be let gone of.

Factually, the ACOG is actually in the process of doing a re-evaluation of its suggestions on the matter. Usually, the main motive for conducting pelvic examinations was for taking Pap smears – samples of cervical cells for checking indications of cancer of the cervix – an annual recommendation since long. However during the later part of 2009 it then did a revision of its suggestions for Pap smear to 2-yearly time intervals in case of females in the age band of twenty-one & thirty who are asymptomatic or not having risk factors, & in 3-yearly time intervals for women in their thirties & more.

Given this alteration, the organization is also re-mulling over other aspects of the yearly examination. At times, when pelvic examination is unnecessary for a particular female, then her fifteen minutes of time with the doctor could be ably spent discussing other crucial aspects.

Alongside Pap test, obstetricians & gynaecologists even conventionally use pelvic exam for checking ovaries & womb for any cancerous indications. The use of duo fingers is done for palpating the organ within whilst the doctor would press on the stomach outwardly – the so-dubbed bimanual examination.

However, Doctor Westhoff & others co-authoring call attention to the fact that bimanual examinations are not leading to early identification of cancer of the ovary & are not suggested for such reason by the ACS, USPSTF & ACOG. These are hardly ever conducted in the U.K. wherein the percentage of females identified with having stage one ovarian cancer is analogous to that in the United States.

Bimanual examinations at times are leading to further testing & methods like removal of ovarian cyst or fibroid which might have subsided by itself, according to Westhoff, who has also noted that a motive for ACOG distancing itself from yearly Pap tests was that irregularities noted there at times were leading to laser excision or biopsy which can be needlessly harmful to patients fertility. For females experiencing stomach pains, backaches or erratic bleedings, ultrasound scanning could decipher additional info as compared to what palpating could do.

Pelvic examinations are additionally deployed for screening presence of STIs & prior to prescription of contraceptive methods given. However the researchers have noted that gonorrhoea, Chlamydia detection could be ably done with analysis of blood or urine testing or via females self-administering swabs. Although pelvic exams are necessary for fitting diaphragms, IUD as contraception, there isn’t any requirement of pelvic exam prior to pills or patches prescriptions being given. However a significant segment of physicians yet need doing a pelvic exam, partly because they have been trained that it is an apt means of tending to patients & no one actually asking why or what one is on the lookout for?

A number of obstetricians & gynaecologists feel that pelvic exams could offer several cues to patients conditions like for instance, approximately gauging how near a female is to menopausal phase by checking colour of the walls of the vagina or even spotting malignant melanoma presence. Moreover, doctors have even detected cancer at the time of rectum examination & polyp formations in the cervix which tends to make sex agonizing.

Bimanual examinations could at times even spot preliminary endometriosis staging, an over-development of uterus lining forming outside it & non-symptomatic fibroid currently that could become problematic in the future.

Doctors even caution that whilst females in committed relationship are not at an elevated risk for cancer of the cervix, several females solely feel that their relationships are exclusive; hence yearly check-up offers added shielding.

Irrespective of pelvic exam conducted yearly or at lesser frequency, it is yet needed regularly & a number of doctors are now laying emphasis of making the experience lesser discomforting to women.

In some medical schools in Canada, the students are guided on the right manner of giving compassionate pelvic exams with advice on speculum being warmed & tested on the skin of the woman firstly and explicating all steps during the pelvic exams to the woman so that nothing is a surprise.