Fewer American women are getting pelvic exams than have in the past 30 years, the latest Centers for Disease Control and Prevention (CDC) data reveal.
Pelvic exams may be dreaded by most women – the awkward stirrups, the crinkly paper, the inevitable ‘scooch down’ and the cold speculum – but according to many experts they should be part of standard care for women over 21.
Only recently, have other doctors begun to buck against that, suggesting the exam is not essential to every annual well-woman check-up exam.
It’s still a hotly debated issue in gynecological circles, but the new CDC report shows that the number of women who got a pelvic exam in the last year has fallen by 19 percent since 1988.
Since 1988, the number of women in all age groups who are getting pelvic exams each year has fallen precipitously, reaching a 30-year low between 2015 and 2017, CDC data show
A pelvic exam is invasive, but, some argue, indispensable for checking the health of a woman’s vagina, cervix and reproductive organs.
Doctors visually examine and use their fingers to feel the vagina, cervix, uterus, ovaries and bladder for any abnormalities and usually take use a swab to collect a sample fora pap smear test (which can give early hints at uterine cancer).
This process is aided by the troublesome speculum, device to dilate, or widen, a woman’s vaginal opening.
The exam can help catch lumps, sexually transmitted infections (STI), signs of infertility or causes of painful sex.
But it has a dark and troubling history.
The speculum was developed by a doctor who tested the device and other ‘medical’ practices on black slave women in the US.
More than a few cases of sexual assault – including the abuses USA Gymnastics coach Dr Larry Nasser was convicted of carrying out against Olympic athletes – have been committed under the guise of a ‘pelvic exam.’
And until recently it was common and almost entirely accepted practice for nervous medical residents to learn to perform pelvic exams by performing them on patients under general anesthesia – and utterly without the knowledge of those patients.
Needless to say, some are not convinced the exam offers more good than harm to the women that undergo them.
Dr Alyssa Dweck, a gynecologist at CareMounty Medical in New York and the author of two books on sexual heath, says that these stories ‘get sensationalized and mentioned,’ whereas ‘routine and above board exams are not reported about.’
Two top medical associations – the American College of Obstetricians and Gynecologists (ACOG) and American College of Physicians (ACP) – were recently at odds over the pelvic exam.
ACOG in 2015 was strongly for the exams, while the ACP urged to do away with it unless a woman was pregnant or doctors had some other reason to suspect she needed one.
Women who are more educated (blue) and more wealthy (green) are more likely to undergo a pelvic exam, the new study suggests
Backing down from its stance somewhat, ACOG now advocates for the exams if a medical history and symptoms indicate it might be necessary, but still says there isn’t really enough evidence ‘for or against’ the exam to make a clear recommendation.
Dr Dweck agrees that a pelvic exam isn’t necessarily called for on every single visit, ‘we do feel our exams are quite valuable and do pick up on things that people may not be aware of.’
In particular she says that any pain, bleeding, or history of symptoms that could suggest infection are still ‘right’ reasons for getting a pelvic exam.
Nonetheless, fewer women are getting the exams.
In 1988, 74.6 percent of 21- to 29-year-olds, 67.2 percent of women between 30 and 44 and 42.3 percent of young women between 15 and 20 had had a pelvic exam in the last year, according to the CDC’s data.
Rates have fallen in every category.
Just 14.9 percent of the youngest age group, 56.5 percent of 21- to 29-year-olds and 64.5 percent of women between 30 and 44 got pelvic exams in the period from 2015 to 2017.
The more educated and wealthy a woman is, the more likely she is to receive an annual pelvic exam.
Non-Hispanic black women had the highest rate of past-year pelvic exams (about 60 percent), followed by white women. Hispanic women had the lowest rate of pelvic exams.
It isn’t clear how these numbers compare to the number of women who have a gynecologists or made well-woman annual visits in the past year, so many questions remain.
‘What these statistics seem to suggest is, sadly, not surprising,’ said Dr Dweck.
‘Access – whether its access to insurance, education or the racial divides that always come into play – seemed to be the only correlation [to the declining rates of pelvic exams] that I could understand.’