The dreaded pelvic exam, the ritual sacrifice of our dignity and bodily autonomy that so many of us dutifully attend year after year, under the impression the archaic exam is a necessary evil-  simply the price we pay for being born with a vagina. But like most aspects of reproductive healthcare, the omnipresent pelvic exam has a lot more to it than meets the eye at first glance. 

If you’re fortunate enough to have escaped pelvic exams thus far in your life it won’t take you long to figure out why they’re dreaded, the exam begins with you removing all of your clothes and dawning a thin scratchy paper dress, essentially a glorified paper towel that offers some semblance of so-called dignity, then a healthcare provider has you lay down on an exam table, put your feet in metal holders called stirrups, and scoot down until it’s ensured your vagina is entirely on display.

Then that healthcare provider proceeds to look at and feel the outside of the vagina (labia, vulva, etc) for abnormalities and signs of STDs or cancer. 

And finally, if that wasn’t invasive and violating enough for you, they insert 2 fingers inside the vagina in what is called a bimanual exam, while pressing down on the abdomen with the other hand, this is followed by a speculum exam where a provider cranks the vagina open with a metal or plastic device called a speculum to visualize the cervix and take cervical cell samples if necessary. Sometimes the pelvic exam also comes with a surprise rectal exam you often neither consented to nor was told would happen.   

 But surely if our health care providers are going to put us through such a violating and invasive exprince they must have good reason to right?

Well no, actually routine pelvic exams do not show any proven benefits, and as of 2017 are no longer reccomended by any reputable helath organizion. 

Pelvic exams were long believed to be the magic bullet of reproductive healthcare and became such a staple in medicine even years after multiple reputable sources disproved their usefulness many providers are still performing them at such a rate an estimated 2.6 million unnecessary pelvic exams were performed between 2011 and 2017, costing young patients approximately 123 million dollars a year - andFor a long time, the pelvic exam was believed to aid in the early detection of really nasty stuff you don’t want living in your body like cancer, endometriosis (when tissue that is supposed to grow inside the uterus grows outside of the uterus) fibroids (noncancerous growths inside the womb) sexually transmitted diseases, and infections, pelvic inflammatory disease, and much, much more.   

 that's just the ones performed on young women and AFB people between the ages of 15 and 20. There are millions more where that came from. 

With most reputable health organizations decrying their use, and no significant evidence backing them up. It's safe to say that reproductive health’s magic bullet was secretly a blank shot all along. 

everything vagina adjacent in healthcare is approximately 100 years behind the curve so it took until 2017 for the lackluster benefits of the invasiveThat's exactly what a 2014 study by the American College of Physicians concluded, and later in 2016, the US Preventive Services Task Force came to the same conclusion that routine pelvic exams showed no significant benefits and issued a recommendation to the US Federal Government that they were unnecessary for asymptomatic, nonpregnant women and AFAB people.

The recommendation came after experts' analyzed over 60 years of data including clinical notes, peer-reviewed papers, and medical journals, as well as a boots-on-the-ground approach of actually talking to patients about what made pelvic exams so awful. The findings showed not only were pelvic exams not an effective screening method for any reproductive cancers, STDs, fibroids, endometritis, or really any other condition the pelvic exam was hailed to be the gold standard diagnostic tool for, the harms of the routine pelvic exam actually far outweighed the limited benefits. 

In addition to both high rates of false-positive (when a test says you have something like cancer but you actually don’t) and false negative (when a test says you don’t have something like cancer but you actually do) results, routine pelvic exams were also determined to not aid in the early detection of disease, prevent illness, or prolong life. Once believed to be a reliable screening method for ovarian cancer, it was also determined that pelvic exams can't even do that, and there is yet to be an acceptable, effective screening method for ovarian cancer.

From a clinical standpoint, the routine pelvic exam just doesn’t hold up to any scrutiny, but the most interesting part of the US Preventive Services Task Force’s findings is what patients had to say about pelvic exams. 

A high percentage of those surveyed said not only did pelvic exams cause them a lot of stress and anxiety, but they also reported delaying or avoiding seeking medical care due to fear of pelvic exams. Something I can personally attest to doing as well, and who could blame me or anyone else? The exam is incredibly invasive, humiliating, dehumanizing, and often quite painful as well, it’s no surprise that people would find them to be anxiety-provoking, embarrassing, and undignified. That alone should have been enough to warrant further investigation into the usefulness of the exam years before the ACP or Preventive Services Task Force started looking into it, as in order for a test to be considered an effective screening method it has to meet certain criteria including that “the test or exam should be acceptable to the population” one would think a test that causes thousands of people to avoid seeking medical treatment solely to avoid it would not be considered an acceptable test to the population. Under this criteria routine pelvic exams should never have been routine in the first place, especially not with credible research debunking them coming out over 60 years ago, but alas  nonsense that is pelvic exams to make headlines.  

You would think people would be ecstatic about routine pelvic exams being a thing of the past, but the Preventive Services Task Force recommendation, despite being very much based on scientific evidence, was extremely controversial and sparked heated debates in both the medical community and people on the receiving end of pelvic exams. With the American College of Obstetrics and Gynecology firing back against the new recommendation, and some patients expressing concerns about how the recommendation might impact their reproductive health. 

The jury didn’t remain out for long though, the evidence is clear, routine pelvic exams show no proven benefits. Whether the ACOG likes it or not.    

Some even went as far as to call the prestigious pelvic exam “useless” and describe it as “an outdated ritual” and they hit that nail right on the head.       

As with many traditions and rituals though, even the most damaging and outdated ones that have no place in a modern civilized society, the pelvic exam is difficult to let go for both the people who have been getting them for decades and the people who have been performing them for decades. 

If you’re a 60-year-old woman who has been getting an annual pelvic exam since you were 21, it’s probably quite befuddling and upsetting when you’re suddenly told that the life-saving staple of your yearly checkup is actually not-so-life-saving and might actually be causing you way more harm then it is doing you good. 

If you’re a health care provider who has spent your entire career indoctrinated into the idea that routine pelvic exams save lives, you might be a bit skeptical of simply stopping performing them, you may let arrogance stand in the way of science and say “well pelvic exams might be useless when performed by someone less skilled than I am, but I know what I’m looking for.” usually followed by a usually braggadocious piece of anecdotal evidence of diagnosing ovarian cancer early and saving a life during a routine pelvic exam or an extremely weird and kinda creepy excuse like saying the exam serves as a trust exercise and an opportunity for women to discuss fertility, birth control, and STDs. Or perhaps it might occur to you that pelvic exams make up a significant part of your revenue stream and that following the science may mean a pay cut.  

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