Every year, millions of young girls and women may be receiving invasive Pap smears and pelvic exams, despite national guidelines recommending that women don't start receiving them until age 21.
, Melissa A. Simon, MD, writes in an editorial accompanying the study. Simon works in the Department of Obstetrics and Gynecology and Center for Health Equity Transformation at Northwestern University’s Feinberg School of Medicine.
“Many women associate the bimanual pelvic and speculum examinations with fear, anxiety, embarrassment, discomfort, and pain,” she says in the editorial. “Girls and women with a history of sexual violence may be more vulnerable to these harms. In addition, adolescent girls may delay startinguse or obtaining screening for sexually transmitted infections because of fear of pelvic examination, which thus creates unnecessary barriers to obtaining important screening and family-planning methods.
And all those unnecessary tests cost money -- the study estimates as much as $123 million each year, just for the pelvic exams and Pap tests. “This is really a well-written and important study,” says Paula Hillard, MD, a professor of obstetrics and gynecology at Stanford University School of Medicine. “We’ve done a good job of teaching gynecologists to do pelvic exams, but only recently people like me who do adolescent gynecology and adolescent medicine are getting across important messages about providing good gynecological care for adolescents.
Jessica Kahn, MD, director of the Division of Adolescent and Transition Medicine at Cincinnati Children’s Hospital, agrees. “The results have significant implications for clinical practice: Education is clearly needed for clinicians to improve awareness of evidence-based guidelines and to ensure that bimanual examinations and Pap tests are performed only when medically indicated,” she said in a statement.
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