When Women Are Fully Informed about Pelvic Exams, Desire for the Exam Plummets

Providing healthy women with information about pelvic examinations, including a professional society’s strong recommendation against them, substantially decreases the patients’ desire for the exam, according to a study led by UC San Francisco.

The study will be published May 18, in the American Journal of Obstetrics & Gynecology.

In recent years, two high-profile organizations have issued conflicting recommendations about pelvic exams.

The American College of Physicians strongly recommended in 2014 against performing pelvic examinations in asymptomatic, non-pregnant women, citing evidence that showed no benefit and some harm. By contrast, the American Congress of Obstetricians and Gynecologists has continued to recommend annual pelvic examinations in symptom-free women beginning at age 21.

In the new study, led by George F. Sawaya, MD, a UCSF Health obstetrician-gynecologist, the impact of this conflicting information on patients’ decisions was investigated.  

“We wanted to take the decision directly to women to see whether the recommendation, and the rationale provided by these groups, would influence women’s desire for the examination,” said Sawaya, a UCSF professor of obstetrics, gynecology and reproductive sciences, and a leader at the UCSF Center for Healthcare Value. Sawaya is also a member of the UCSF Helen Diller Family Comprehensive Cancer Center.

In the study, 190 women visiting health clinics at UCSF and Zuckerberg San Francisco General Hospital and Trauma Center were shown illustrations of the pelvic examination. Then they were randomly assigned to review a summary of one of the two recommendations.  

Afterward, the women answered a series of questions assessing their attitudes and beliefs about the examination. The summary by the American College of Physicians included information about the potential for false-positive testing and unnecessary surgery. The summary by the American College of Obstetricians and Gynecologists disclosed the lack of evidence of benefit, but did not mention the possibility of harm.

The results were dramatic. Desire for the examination dropped from 82 percent for women who reviewed the favorable recommendation to 39 percent for those reviewing the discouraging recommendation. More than 90 percent of women in the study said that potential benefits and harm should be discussed prior to the examination.

“For every two or three women shown the recommendation, one of them would opt out of the examination,” said Sawaya. “This is an enormous effect for a five-minute education intervention.”

Pelvic examinations have long provided the foundation of the annual well-woman medical visit, with millions of healthy women undergoing the exam annually. In 2012 alone, more than 44 million pelvic exams were performed in the United States, according to the Centers for Disease Control and Prevention.  

“Given the potential public health impact of our findings, we think there is a pressing need for improving patient counseling concerning this exam,” said senior author Miriam Kupperman, PhD, MPH, a UCSF professor in the departments of Obstetrics, Gynecology and Reproductive Sciences, and Epidemiology and Biostatistics.

“These findings point to the need for educational materials to ensure women’s informed preferences and values are reflected in decisions about pelvic examinations,” Kupperman said.   

The study’s other authors are Karen K. Smith-McCune, MD, PhD, a UCSF professor in the Department of Obstetrics, Gynecology and Reproductive Sciences, and a member of the UCSF Helen Diller Family Comprehensive Cancer Center; Steven E. Gregorich, PhD, a UCSF professor of medicine; and Michelle Moghadassi, MPH, a UCSF lead data analyst.

The research was supported in part by a grant from the National Cancer Institute (1R01CA169093).

UC San Francisco (UCSF) is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. It includes top-ranked graduate schools of dentistry, medicine, nursing and pharmacy; a graduate division with nationally renowned programs in basic, biomedical, translational and population sciences; and a preeminent biomedical research enterprise. It also includes UCSF Health, which comprises three top-ranked hospitals, UCSF Medical Center and UCSF Benioff Children’s Hospitals in San Francisco and Oakland, and other partner and affiliated hospitals and healthcare providers throughout the Bay Area.