Back to News Releases Jennifer Forbes
Communications & Public Affairs
732-235-6356, jenn.forbes@rwjms.rutgers.edu
Pelvic Exams are Necessary Preventive Medicine
Rutgers Physician Gloria Bachmann Discusses New Controversial Recommendations
New Brunswick, NJ -- The United States lags behind other developed countries when it comes to preventive medicine, yet research has shown that primary care, which includes routine health exams and well-woman exams, improves health outcomes and reduces costs. Through regular preventive screenings, physicians can discover, treat, and help patients to manage health concerns early, before they become serious or chronic conditions which may require specialists and more invasive medical interventions.
Earlier this week new guidelines were released, which recommend that pelvic exams–a routine health exam for women–no longer be given annually to women who are typically healthy and have no gynecologic or bladder indications or concerns.
Gloria Bachmann, MD, a women’s health expert and interim chair of obstetrics, gynecology and reproductive sciences at Rutgers Robert Wood Johnson Medical School, suggests that the pelvic exam should continue to be a part of the annual exam for women. The final decision, she believes, to have it or not to have it during an annual well woman visit should belong to the patient with the input of her physician. Dr. Bachmann discusses the importance of routine pelvic exams and the reason for the controversy:
Question: What is a pelvic exam?
Dr. Bachmann: A pelvic exam is just one part of a woman’s wellness exam that should happen once each year. It is a comprehensive examination of the uterus and reproductive organs, as well as the bladder, rectum and abdomen. The pelvic exam is often the starting point for a detailed conversation about important issues that affect women, including pre-pregnancy counseling, infertility, and menopause. Many people may believe that it is only a Pap test, which is used to screen for cervical cancers and disorders, but that is only one part of a pelvic exam.
Question: What else does a pelvic exam encompass?
Dr. Bachmann: There are many other screening procedures that are included in a pelvic exam, in addition to a Pap test. These include cultures for infection, some for which there may not be apparent symptoms by the woman early on, including sexually transmitted infections. Physicians also conduct pelvic exams to determine if a woman has an enlarged or painful uterus or a weakened pelvic floor, with relaxation of the bladder.
Question: Why are the new recommended guidelines controversial?
Dr. Bachmann: The American College of Physicians evaluated several studies and concluded that there was insufficient evidence to support annual pelvic exams in women with no symptoms or who are of average health; this is in contradiction to recommendations of the American College of Obstetricians and Gynecologists. Evidence shows that primary care, of which pelvic exams are one part, reduces overall healthcare costs for both patients and institutions. Through annual health exams and screenings, physicians can identify potential health problems in patients. Early identification allows early intervention to treat or manage the condition, therefore reducing the risk of it becoming a serious or chronic condition.
Question: Why do you, as a physician, feel that pelvic exams are important?
Dr. Bachmann: According to The Organisation for Economic Co-operation and Development, the United States already lags behind other developed countries in providing preventive health care, with primary care visits of four per person annually. In Europe, the average is six-and-a-half, with France at nearly seven and Germany at more than eight primary care visits per year. Discouraging pelvic exams removes a preventive health screening, and in so doing, women also may forego their overall annual health check up with their primary care physician, such as their gynecologist. . I feel strongly that we should not take away services that can support women’s health. Conditions may be found through pelvic exams that can improve a woman’s reproductive health, sexual health and overall well-being.
Question: When is the pelvic exam not routine?
Dr. Bachmann: Any woman who is not pregnant and experiences certain symptoms should have a pelvic exam. They include: pelvic pain or severe pain with menses; menstrual irregularity; abnormal or heavy vaginal bleeding or discharge; any skin lesions on the outer vaginal area; sexual pain; bladder symptoms such as loss of urine or burning with urination; or discomfort, burning, pressure or irritation on the outer vaginal area.
Question: What do you recommend to women who are confused by the new recommendations?
Dr. Bachmann: Women should be empowered to make their concerns and desires regarding a pelvic exam known to their clinician. A pelvic exam, like an eye exam or a dental exam, may detect potential or early problems. The pelvic exam can also be the impetus to initiate a conversation with a clinician about vaginal dryness, heavy bleeding or chronic pelvic discomfort from bladder relaxation. If a woman has had pelvic exams regularly and is comfortable with them, or if she chooses not to have a pelvic exam regularly, this is the discussion that she and her clinician should engage in. I want my patients to be empowered and to tell me, as the physician, what they want and what they don’t want. It’s my job to listen to my patients’ concerns and if I believe there is a reason for a screening or preventive measure, such as a pelvic exam, I need to discuss it with my patients and get their consent. Together, we can decide on the best course of care.
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