More Than Half Of US Women Under 21 Are Receiving Unnecessary Pelvic Exam

Of the more than 3,400 women between the ages of 15 and 20 analyzed, more than half had received a pelvic exam within the previous year that was deemed potentially unnecessary. Iryna Inshyna/Shutterstock

Millions of women in the US between the ages of 15 and 21 are receiving potentially unnecessary pelvic exams and cervical cancer screenings with possibly unhealthy side effects, new research suggests. Undergoing needless tests can lead to false-positive test results, which may increase associated anxiety and medical costs as well as prompt unnecessary treatment.

"Many young women associate the examination with fear, anxiety, embarrassment, discomfort, and pain. Some adolescent girls and young women may forgo contraception or STI screening because of fear associated with these exams, which could lead to unintended pregnancies and may increase overall health risks," study author Jin Qin told IFLScience.

To determine the prevalence of young women in the US receiving either a bimanual pelvic examination (BPE) or a Papanicolaou (Pap) test, researchers at the University of California San Francisco (UCSF) and the Centers for Disease Control and Prevention (CDC) analyzed survey data between 2011 and 2017. Of the more than 3,400 women between the ages of 15 and 20 analyzed, more than half had received a pelvic exam within the previous year that was deemed potentially unnecessary.

This analysis found that more than half of BPEs and almost three-quarters of Pap tests were potentially unnecessary, exposing women to preventable harms, note the authors in JAMA Internal Medicine.

Roughly one-in-five young women received a BPE or Pap test in the last year, almost all of which were performed at the same time. More than half of BPEs and nearly three-quarters of Pap tests were deemed potentially unnecessary. Based on these results, the authors speculate that 1.4 million pelvic examinations and 1.6 million pap tests performed on females between 15 and 20 years across the country are medically unnecessary. Additionally, young women who were using some sort of birth control were 75 percent more likely to get a pap test and 31 percent more likely to receive a pelvic exam even though neither exam is needed to receive most hormonal contraceptives or screen for most STIs. Qin told IFLScience that the researchers are not sure why millions of girls are still receiving the exams, but added that "unlearning is difficult". 

"Routine screening pelvic examination has long been performed in women during annual preventive visits. In addition, a pelvic examination has traditionally been performed to screen for sexually transmitted infections or prior to prescription of hormonal contraception. It could be difficult to change the old practice that lasted for decades," said Qin.

A physician conducts a BPE by inserting two fingers into the vagina while also providing external pressure in order to inspect the vagina and other reproductive organs, which the study authors describe as an “invasive and controversial examination component.” Nearly every BPE was done in conjunction with a Pap test, whereby a doctor places a speculum inside the vagina to collect cells from the cervix in order to screen for cervical cancer.

Women under the age of 21 should not be screened for cervical cancer, regardless of the age of sexual initiation or other risk factors, according to guidelines set forth by the American Cancer Society, American Society for Colposcopy and Cervical Pathology, and the American Society for Clinical Pathology. Only women within this age group who are pregnant or present symptoms should consider such testing. Pap tests should only be repeated every three years following normal results. The results suggest a lag in clinical practice despite professional guidelines and recommendations – a cost that adds up to an estimated $123 million each year.

The authors are quick to note that they used self-reported data, which may have reporting errors and presents difficulties in verifying accuracy. Even so, they suspect that their estimation is conservative and suggest the need for education to improve awareness of professional guidelines. Qin encourages parents and patients to ask their healthcare providers about why and when these exams and tests are needed.

An illustration depicting a pap smear. Shown are a cervical scrape smear (top), a cervical swab smear (bottom left), and an endocervical aspirator (bottom right). Medical Art Inc/Shutterstock

 

 
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