Many Girls, Young Women Getting Unnecessary Pelvic Exams

Many American teen girls and young women under the age of 21 are undergoing pelvic exams and Pap tests they just don't need, a new study finds.

"Parents of adolescents and young women should be aware that cervical cancer screening is not recommended routinely in this age group," said study senior researcher Dr. George Sawaya. He is professor of obstetrics, gynecology and reproductive sciences at the University of California, San Francisco.

Sawaya also stressed that "pelvic exams are not necessary prior to getting most contraceptives and are often not needed to screen for sexually transmissible infections."

However, this study found that millions of females aged 15 to 20 unnecessarily receive the exams. That can lead to false-positive results, overtreatment, anxiety and needless expense, the research team said in a university news release.

One obstetrician-gynecologist who wasn't involved in the new report said its findings echo those of prior studies.

Clearly, "better adherence to recommended guidelines developed from evidence-based studies is appropriate and necessary," said Dr. Mitchell Kramer. He directs obstetrics and gynecology at Northwell Health's Huntington Hospital in Huntington, N.Y.

"Getting the message out to women's reproductive health care providers regarding these guidelines needs to improve," Kramer said.

In the new study, Sawaya's group tracked 2011-2017 U.S. government data on more than 2.6 million patients aged 15 to 20. All had received a pelvic exam during the previous year.

The data showed that the exam was potentially unnecessary in more than 54% (1.4 million) of the patients.

In addition, nearly one-fifth of females younger than the recommended age of 21 had undergone a Pap test within the past year. About 72% (1.6 million) of those tests were performed as "part of a routine exam" and were potentially unnecessary, the researchers said.

In nearly all cases, pelvic exams were conducted at the same time as the Pap test, according to the study published Jan. 6 in JAMA Internal Medicine.

Teens and young women who'd been screened for a sexually transmitted infection were almost four times more likely to have had a Pap test and 60% more likely to have had a pelvic exam than those who hadn't been screened, the researchers found.

Teens and young women who used hormonal birth control -- for example, the contraceptive pill -- were 75% more likely to have a Pap test and 31% more likely to have undergone a pelvic examination, versus those who did not use such birth control methods.

All of these unnecessary tests add greatly to health care costs, Sawaya's group noted. They estimated the cost of unnecessary pelvic exams and Pap tests in females younger than 21 to be about $123 million a year.

According to the study's lead author, Jin Qin, "This study suggests that health care providers and young women need to communicate clearly and often about the best time for these tests." Qin is an epidemiologist in the division of cancer prevention and control at the U.S. Centers for Disease Control and Prevention.

"We want to ensure that guidelines are followed, and lives are saved," Qin added in the news release.

For his part, Kramer believes that "the majority of ob-gyns agree with the recommendations regarding not performing Pap smears in patients prior to age 21 unless there is a strong medical issue or problem."

And, he added that "the same applies for pelvic exams, with the caveat that the patient has no significant problems or complaints that would warrant a physical exam."

In many cases, even if "problems or complaints" exist, a young patient can undergo a pelvic ultrasound test in lieu of a physical pelvic exam, Kramer noted.

Still, the decision to administer a pelvic exam in younger patients is one best decided on a case-by-case basis, he added.

"I would emphasize these are guidelines only, and each patient's situation should be evaluated individually by the health care provider, so as not to avoid or neglect a situation or condition that warrants a Pap smear or pelvic exam," Kramer said.

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