Our expert is Kathleen McIntyre-Seltman, MD, Professor, Department of Obstetrics, Gynecology & Reproductive Sciences, University of Pittsburgh.

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Mitzi Perdue

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FOR ASYMPTOMATIC INDIVIDUALS, MANY COMMONLY PERFORMED PHYSICAL EXAMINATIONS ARE NOT JUSTIFIED

The U. S. Preventive Services Task Force (USPSTF) has been evaluating a variety of commonly performed diagnostic tests. Their conclusion is that in the very specific case of individuals who are not symptomatic, many of the physical exams that we routinely perform are not justified. Patients with no symptoms relating to their heart, lungs or abdomen, probably will not need some of the physical examinations that we have been routinely performing. Specifically, procedures such as listening to an asymptomatic patient’s heart, chest, or checking her abdomen have proven to have a very low yield in terms of clinically useful information. There’s robust evidence that in these cases, instead of spending the time on the physical examination, taking a detailed clinical history is more important for producing the best health outcomes.

TESTS THAT ARE JUSTIFIED, WHETHER THE INDIVIDUAL IS SYMPTOMATIC OR NOT

The following clinical approaches have proven to be associated with better health outcomes: information on the patient’s height, weight, blood pressure, and also lab work that screens for diabetes, hemoglobin and A1C. Evaluating the results of these tests is likely to produce better information than physical exams would for asymptomatic individuals. Further, the time saved by not doing physical exams for asymptomatic individuals can mean time spent on preventative medicine, including promoting healthy behaviors.

PELVIC EXAMS – IN SOME CASES, THEY’RE NOT WORTH IT

For the case of a woman over 25 years old who has no symptoms, the incidence of pelvic pathology is low. Adding to this is the fact that a physical examination in the absence of symptoms rarely leads to a useful diagnosis. Because of these two considerations, the USPHTF concluded that a pelvic exam in many cases is not justified for an asymptomatic woman who is over 25. However, some women may want the reassurance of a pelvic exam. If she feels strongly about this, and since this is a low-risk procedure, there’s no compelling reason not to go along with her wishes.

PELVIC EXAMS – IN SOME CASES, THEY’RE HIGHLY RECOMMENDED

In the case of a woman over 21 years of age and under 25, we do recommend an annual pelvic exam. The purpose is for STI screening, not for other reasons, so a bimanual exam is not always needed if she has no symptoms. If she’s over 25 and has multiple partners or if her partner has multiple partners, an annual pelvic exam is recommended. Further, at any age, if she has symptoms such as burning, itching, a strong odor, heavy bleeding or bleeding between periods, or significant pelvic discomfort, she should have a pelvic exam. An abnormal Pap smear requires a pelvic exam as well as more frequent Pap smears. Others who will benefit from a pelvic exam include women with severe or worsening cramps, the kind where OTC medications are not working. She should also have a pelvic exam if there’s bleeding after menopause, or infertility, or painful intercourse. She should discuss any symptoms, even if they seem mild, with her health care practitioner.

Things to look out for include benign muscle growth in the uterus, or endometriosis or prolapse or infection or scar tissue from a prior surgery. In any of these cases, she would need a detailed exam to facilitate further evaluation.

THE GUIDELINES FOR PAP TESTS

Our understanding of the usefulness of Pap tests is evolving. There are new algorithms that may change our current recommendations, but as of now, the recommendation holds that women between 21 and 30 should get Pap testing each year, without automatic HPV testing. After age 30, she should be screened every 5 years if Pap testing and HPV are done together. If only Pap testing is done without a test for HPV, screening should continue every 3 years. After age 65, she can skip that Pap testing altogether if her tests up to that age have been normal.