‘Routine pelvic examination … rarely detects important disease and does not reduce mortality and is associated with discomfort for many women, false positive and negative examinations and extra cost,’ said Dr. Linda Humphrey, a co-author of the American College of Physicians’ new guideline. But Dr. David Fishman, a gynecologic oncologist and director of the Ovarian Cancer Risk Assessment Program at Mount Sinai Hospital, notes, ‘The bimanual/rectovaginal examination not only detects asymptomatic gynecologic disease but also diseases of the colon and rectum.’

The American College of Physicians is recommending against pelvic exams that gynecologists have routinely performed for decades on nonpregnant, healthy women during their annual checkups.

The ACP’s new clinical practice guideline was published Monday in the Annals of Internal Medicine, the organization’s journal.

“Routine pelvic examination has not been shown to benefit asymptomatic, average risk, nonpregnant women. It rarely detects important disease and does not reduce mortality and is associated with discomfort for many women, false positive and negative examinations and extra cost,” said Dr. Linda Humphrey, a co-author of the guideline and a member of ACP’s Clinical Practice Guidelines Committee.

Humphrey noted that the guideline does not apply to Pap smear screening, only the pelvic examination.

A pelvic exam is typically part of a woman’s routine wellness exam to find possible signs of a variety of disorders, such as ovarian cysts, sexually transmitted infections, uterine fibroids or early-stage cancer.

Often dreaded by women, the exam consists of the doctor inserting a lubricated, gloved finger into the vagina and with the other hand, pressing down on her abdomen to check the shape and size of her uterus and ovaries.

It’s called a bimanual exam. Some doctors also include a rectal exam as well while women are up in the stirrups.

“I would like women to see this ACP recommendation as good news,” said Dr. Carolyn Westhoff, a professor of obstetrics and gynecology at Columbia University Medical Center. “In a person with no complaints, is it worth doing anything to them?”
Broadway star Valisia Lekae says a pelvic exam saved her life when it caused her doctor to discover she had ovarian cancer.

Westhoff published a medical journal article in 2011 questioning the need for the annual pelvic exam in the absence of any symptoms such as vaginal discharge, abnormal bleeding, pain, urinary problems or sexual dysfunction.

“I think the ACP is right on target,” she said. “The exam is so embedded in a gynecologist’s practice. It’s how we’ve all been trained to take care of our patients. But it’s way out of date.”

The American College of Physicians, with 137,000 general internists and related specialists, is the nation’s second-largest physicians’ organization.

The guideline is sure to stir controversy.

The American College of Obstetricians and Gynecologists remains in favor of annual pelvic exams.

That group “continues to firmly believe in the clinical value of pelvic examinations,” it said in a statement, adding the exams help gynecologists “explain a patient’s anatomy, reassure her of normalcy and answer her specific questions.”

And some New York ob-gyns and patients were also quick to blast the ACP’s new guideline.

“The bimanual/rectovaginal examination not only detects asymptomatic gynecologic disease but also diseases of the colon and rectum,” said Dr. David Fishman, a gynecologic oncologist and the director of the Ovarian Cancer Risk Assessment Program at Mount Sinai Hospital. “The majority of women who develop ovarian cancer do not have risk factors and often have asymptomatic masses which are often appreciated during the pelvic examination.”

Take the case of one of his patients, Broadway actresss Valisia LeKae, 34.
LeKae, who was nominated for a 2013 Tony Award for her performance as Diana Ross in the musical “Motown,” was diagnosed with ovarian cancer in December.

She said discomfort she felt during a pelvic exam by her gynecologist. Dr. Fishman then sent her for an ultrasound for further evaluation. His suspicions were correct. A small cyst was found, followed and then operated on.

“Honestly, I was a little shocked when I read the guideline because it is an exam like this that helped save my life,” said LeKae, who is now the spokeswoman for the National Ovarian Cancer Coalition.

“I would ask women to make an educated response for their bodies, and to be as proactive as possible,” added LeKae, who underwent chemo and surgery and is now cancer free. “If I didn’t have those exams regularly I wouldn’t have known that the cyst had tripled in size, was cancerous and could have ruptured, spreading cancer all over my body.

“Instead I was able to get it early — Stage 1 aggressive — and contained to the right ovary,” she said.

The new guideline does not apply to Pap smear screening for cervical cancer, which should be done every three to five years, depending on a woman’s age and past history.

Read more: https://www.nydailynews.com/life-style/health/doctor-group-urges-gynecological-pelvic-exams-article-1.1849891#ixzz36ysmzNRh

SOURCE:  NY Daily News