Despite Guidelines, Many Young Women Still Receive Unnecessary Pelvic Exams

A new study found that many adolescent women continue to undergo pelvic examinations and Papanicolaou (Pap) tests, even though current guidelines suggest they may not be necessary.

In the U.S., it is not recommended that women aged younger than 21 years undergo cervical cancer screening. Further, pelvic exams are no longer recommended for women without symptoms or who are not pregnant, as this is an invasive procedure that could yield “false-positive test results, overdiagnosis, anxiety, and unnecessary costs,” the study authors explained.

The researchers sought to determine how many healthy women aged younger than 21 years were still undergoing the bimanual pelvic examination (BPE) and Pap test, as well as what factors correlated with these exams.

They conducted a cross-sectional analysis of the National Survey of Family Growth, specifically analyzing data on women aged between 15 and 20 years. Data spanned September 2011 and September 2017 and were evaluated between Dec. 21 2018, and Sept. 3, 2019. The primary outcome was 12-month receipt of a BPE or Pap test and how many of these procedures could be considered unnecessary.

Most Pelvic Exams Unnecessary

Final analysis, published in JAMA Internal Medicine, included 3,410 women. Overall, 4.8.% (95% confidence interval [CI], 3.9%–5.9%) of women in the study sample were pregnant, 22.3% (95% CI, 20.1%–24.6%) had received testing for sexually transmitted infection (STI), and 4.5% (95% CI, 3.6%–5.5%) were treated for an STI in the past 12 months. Just 2.0% (95% CI, 1.4%–2.9%) of women reported using an intrauterine device (IUD), and 33.5% (95% CI, 30.8%–36.4%) reported using at least one other form of hormonal contraception in the last year. A little under a quarter of respondents (22.9%; 95% CI, 20.7%–25.3%)—about 2.6 million women—reported that they underwent a BPE in the past 12 months. Of these exams, a little more than half (54.4%; 95% CI, 48.8%–59.9%)—representing about 1.4 million women—may have been unnecessary. The following factors were correlated with undergoing a BPE: having a Pap test (adjusted prevalence ratio [aPR]=7.12; 95% CI, 5.56–9.12), testing for STIs (aPR=1.60; 95% CI, 1.34–1.90), and using hormonal contraception that was not an IUD (aPR=1.31; 95% CI, 1.11–1.54). About 2.2 million women—19.2% of the study population (95% CI, 17.2%–21.4%)—underwent a Pap test in the last 12 months; 71.9% (95% CI, 66.0%–77.1%) of these tests may not have been necessary.

“Recommendations and guidelines have evolved over time,” lead study author Jin Qin, ScD, who works for the U.S. Centers for Disease Control and Prevention, told Reuters in an email. “Prior to 2012, guidelines recommended starting cervical cancer screening at or around onset of sexual activity or age 21, whichever came first. In 2012, recommendations from major organizations agreed that the initiation age [should] be 21 years regardless of sexual behaviors and risk factors. Leading professional organizations have issued or updated their recommendations regarding pelvic examination since 2014, recommending against pelvic examination among women who are not pregnant or have no symptoms.”