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More than 1.4 million young women over a six-year period received pelvic exams or Pap smears they might not have needed, a new national study published in the peer-reviewed medical journal JAMA Internal Medicine estimates — suggesting that doctors, young women and their parents should familiarize themselves with the most up-to-date guidelines and potential risks.
Researchers from the Centers for Disease Control and Prevention and the University of California, San Francisco analyzed data from September 2011 to September 2017 from 3,410 respondents to the CDC’s National Survey of Family Growth.
‘Many young women associate the examination with fear, anxiety, embarrassment, discomfort and pain.’
Among the sample of girls and women aged 15 to 20, 54% of pelvic exams they had received in the past year (representing around 1.4 million people) were “potentially unnecessary,” the study found, as were nearly 72% of Pap tests performed in the past year (1.6 million). Pap tests, which are used to screen for cervical cancer, generally aren’t recommended for women under 21.
Jin Qin, a CDC epidemiologist, a co-author of the study, recommends asking about alternative STI screening methods, including urine or self-collected samples, and consulting with their doctor about when and why such exams and tests might be needed. Women don’t need a pelvic exam or Pap test prior to starting most hormonal contraception (save for an intrauterine device) and they often aren’t necessary to screen for sexually transmitted infections.
The tests cost upwards of $123 million in a year, the researchers estimated, using 2014 Medicare payment data that specified $37.97 for a pelvic exam and $44.78 for a Pap smear. These potentially unneeded screenings can result in “false alarms, unnecessary treatment, and needless cost,” Qin told MarketWatch in an email.
“Many young women associate the examination with fear, anxiety, embarrassment, discomfort and pain,” Qin said. “Some adolescent girls and young women may forgo contraception or STI screening because of psychological stress associated with these exams, which could lead to unintended pregnancies and may increase overall health risks.”
The American College of Physicians and the American Academy of Family Physicians advise against pelvic exams on women who aren’t pregnant and don’t have symptoms.
After all, many professional organizations have revised their recommendations on these exams in recent years. Groups like the American College of Obstetricians and Gynecologists (ACOG), the U.S. Preventive Services Task Force and the American Cancer Society now only advise Pap tests to screen for cervical cancer starting at age 21, “regardless of sexual behaviors and risk factors,” Qin said.
The American College of Physicians and the American Academy of Family Physicians advise against pelvic exams on women who aren’t pregnant and don’t have symptoms, Qin added.
But research shows that many medical professionals still regard pelvic exams “a useful tool to screen for gynecologic cancers” despite the stated guidelines, Qin said, perhaps because it had long been a routine screening during annual preventive visits. Health-care providers may not be aware of how professional recommendations have evolved, Qin suggested, and need to be educated on the most recent guidance.
“There is also lack of knowledge and misunderstanding in the public,” the epidemiologist said. “Patients often don’t know the purpose of [a] pelvic exam and Pap test, and yet many believe it is necessary for STI screening, contraception initiation, and cancer detection. Most young women think they need routine and frequent pelvic examination and Pap test.”
