July 14, 2014

"Doctors Are Examining Your Genitals for No Reason."

But what is the reason to be telling us now that "Doctors Are Examining Your Genitals for No Reason"?

I'm a bit skeptical about all the articles on the senselessness of various medical procedures we've been paying for all these years. I suspect it has to do with the big upheaval in health insurance. Now that everyone's covered — supposed to be covered — it's suddenly time to say that's not worth covering.

The linked article is talking to women. If you're a man, these aren't "Your Genitals" we're talking about. This is about the "pelvic exam" women know so well. It's a damned strange thing to submit to if there's "No Reason" for it!

In 2010, doctors performed 62.8 million of these routine pelvic examinations on women across America. In total, gynecological screenings cost the U.S. $2.6 billion every year. And yet, a new study published in the Annals of Internal Medicine reports that there is no established medical justification for the annual procedure. 
Does that justify the headline — "No Reason"? It seems to me that it's a cost-benefit analysis.
After scouring nearly 70 years of pelvic exam studies, conducted from 1946 to 2014, the researchers found no evidence that they lead to any reduction in “morbidity or mortality of any condition” among women. In light of the study, the American College of Physicians, a national organization of internists, has crafted a new set of guidelines warning doctors that exams conducted on otherwise symptomless women can “subject patients to unnecessary worry and follow-up” and can “cause anxiety, discomfort, pain, and embarrassment, especially in women who have a history of sexual abuse.”

54 comments:

Ignorance is Bliss said...

Because they're there always seemed like more than enough reason for me.

madAsHell said...

Would you like it better if the doctor just asked a few questions, and then stuck a finger up your ass?

rhhardin said...

It's a popular topic for sociology dissertations. Division into acts and scenes is common for desexualization effects. Strip clubs also are popular, for their opposite effect, not really sexual presented as sexual.

Probably the pelvic exam practice started with primitive medicine men, if you want a historical guess.

SomeoneHasToSayIt said...


Well, I can think of a reason, but I'm not a doctor.

dreams said...

I decided years ago that the reason for a rectal exam didn't justify my discomfort with the procedure.

Anonymous said...

I always wondered why my dentist insisted upon seeing my penis.

Zedediah Grimm said...

Hey Althouse. You need to step up your game. There was an obvious need for a trigger warning on this post. Wouldn't want anyone to go into a psychotic break from reading your blog ... or maybe you do. Hmmmm ...

Bob Ellison said...

betamax3000, that made me LOL.

My dentist keeps telling me that dirty teeth lead to heart disease, and I should be especially concerned about that because I have diabetes. That's the latest fad in dentistry.

But he hasn't asked to see my penis. I think he probably really doesn't want to go there.

SGT Ted said...

And when doctors reduce looking at the female parts and then something goes wrong, they will then blame the doctor, as well as file a malpractice lawsuit, for *not* examining their lady parts more often.

This female schizophrenia when it comes to medically necessary invasiveness and security is on of the roots of the problems with modern medicine.

Hagar said...

Some years ago all the doctors wanted to look in my ears. I think it is just about which studies get written up in the medical journals with the largest circulation.

Anonymous said...

Terrible Reading Comprehension Guy says:

Althouse says: "It's a damned strange thing to submit to if there's "No Reason" for it!" So: the Professor wants women to return the Vagina Dark Ages, wherein lies only Dank Mystery and the Possibility of Teeth. I, for one, see nothing wrong in women having their lady parts examined for teeth; Althouse, on the other hand, obviously has no problem with women keeping their vaginal teeth hidden. Keep this in mind, readers.

tim maguire said...

There are probably a lot of unnecessary medical exams going on out there for defensive purposes. But lawsuits are also a major driver of health care quality.

One answer (not saying it' a simple answer, just that it is an answer), is to develop more specific guidelines for standards of care such that a doctor meeting them enjoys a presumption of non-negligence.

David said...

I will worry when they start giving women prostate exams.

EDH said...

"Could you take a look at my penis?"

sojerofgod said...

This is in the same vein with the recent pronouncement that women over a certain age do not need to get annual mammograms. Quote me your damned lies and statistics all you want (yes, they are one and the same) but I know damn good and well the real reason they insist that these tests are unnecessary is to save the insurance industry money. Insurance is a numbers game. sure, if you don't provide the yearly test some additional women will get sick and die from cancer, but when they crunch the numbers restricting tests for millions saves more than paying for cancer in thousands.
The individual is a meaningless statistic and their suffering is of no consequence.
Studies like this allow the insurance industry cover to deny coverage of these tests. The women who get cervical cancer and die? well that's just tough ain't it. If you could scratch the surface to see who exactly funded this study and how they laundered the money, you would see a trail of blood leading back to the insurance companies.

Yeah, yeah, I know we need to have health insurance; My opinion is that the Government's meddling in the Medical industry for the last 50 years is actually the cause of much of the increase in medical costs. that does not exonerate companies and trade associations who are willing to trade my life or that of my family for their profits.

The Drill SGT said...

Would you like it better if the doctor just asked a few questions, and then stuck a finger up your ass?

you forgot the "palpitating your testicles " part.

seriously though, the most intrusive sexual exam I ever had was at Travis, coming back from Nam in '71.

In that case, they were sticking what resembled a q-tip head on a wire probe up your urethra, about 1-2 inches and then scraping the insides looking for STD's.

not fun on several levels....

Michael said...

Odd, this. On top of the sudden discovery that PSA tests are worthless, annual physicals a waste of time, mammograms pure voodoo.

I believe on these matters I will become, and would recommend women become, Opposite Person.

Bruce Hayden said...

I am still a bit surprised that physicians are still using cold specula for this procedure. Remember a woman in college (maybe 45 years ago) picking her ob/gyn based on just this - whether they would heat the vaginal specula first. This may have contributed to her decision to go to med school (though she ended up in a different specialty). And, the ob/gyn who delivered my kid would not have dreamed of using a cold one. Was this a passing fad? Or, just a yuppie thing?

Xmas said...

Bob,

Dirty teeth do lead to heart disease.

"However, some [bacteria] may get into the blood if you have an infection or wound in another part of the body. In particular, dental and mouth infections are situations where bacteria can quite easily get into the bloodstream."

http://www.patient.co.uk/health/infective-endocarditis-leaflet

Dental abscesses can lead to all sorts of issues. Be sure to floss, boys and girls.

More on topic, how often do women have "no symptoms" with their genitals? There's always something going on down there: pain, cramps, weird discharge, funny smell, yeast, bumps, too much blood, not enough blood.

(On a side note, if they come out with a male birth control pill that requires a yearly prostate exam, it'll never go anywhere.)

Anthony said...

I've been attempting without success to have my dentist's office manager show some interest in my gentleman's area.

But yes, now that The Great and Good Government will be doling out health care it's death panels all the way down.

fivewheels said...

Obvious question from a non-doctor: Does the pelvic exam turn up health issues that are non-lethal? Mortality is not the only measure of the usefulness of a procedure, but it's the only one mentioned here.

This is a "consider the source" kind of story if I ever saw one.

Ann Althouse said...

"Obvious question from a non-doctor: Does the pelvic exam turn up health issues that are non-lethal? Mortality is not the only measure of the usefulness of a procedure, but it's the only one mentioned here."

Look up the word "morbidity," which is also used here.

Todd said...

Now that uncle is picking up the tab as well as writing the regs, I suspect you will see a whole lot more of these "no effective" studies and articles telling us that all of those "oh so necessary" tests really are not so necessary after all, whether they really are or not.

I would not believe the AMA or the Government these days if they told me I was on fire and I felt the heat.

Anonymous said...

Its not clear from the article whether we are speaking of pelvic exams with collection of a PAP smear, or a simple pelvic exam (trans vaginal physical exam of ovaries, uterus and uterine adnexa) without the collection of a PAP smear. As these two procedures are routinely performed at the same time, and most of the 'disagreeable' parts of the pelvic exam have been performed to get the PAP smear(usually done first), then it can be said that, as a practical matter, the two procedures are hard to separate, and it makes no sense not to go ahead and do the pelvic exam at that point. Docs think of the routine collection of a PAP smear as part of a 'pelvic exam'. When you combine this with the fact that the routine PAP smear exam has virtually eliminated a deadly and once fairly common disease -invasive squamous cell carcinoma of the uterine cervix- then this article is misinformative and impertinent in the extreme. If we were to get away from routine pelvic exams, with collection of a PAP smear, then female patients will eventually start presenting with higher stage (potentially more lethal) malignancies.

fivewheels said...

Whoopsie. I guess I thought "mortality and morbidity" was one of those phrases that repeats the same concept, like, uh, "wrack and ruin." Seemed reasonable at the time, given the usual association of death with the word morbid. Live and learn.

Paul said...

I've always wondered why women chose male doctors in this day and age.

I have a male dr. (but then I am a male) and even then it's a bit uncomfortable swinging my, uh, thing in front of him to 'examine'. I can imagine a woman being kind of scandalized (well SOME women are) at a dr. of the opposite sex messing with her.

Now is the exam necessary? I hope so but it's kind of hard (no pun intended) to make a 100 percent accurate decision if the exam is needed or not.

Thus I suggest women go to more women doctors and men to male doctors.

Sexism? Maybe, but unless you are a uninhibited nudist I bet you do have some reservations about who fiddles with your intimate parts.

Anonymous said...

It's very important to be, at least, a partially informed patient. Understanding the limitations of science & medicine; it's best to take charge & make your own decisions about procedures & examinations. Don't let doctors do as they please unless they have convinced you of necessity &/or you're convinced. They work for you.
That said, this is way too much information for me, being male & totally at a loss when it comes to women's issues.

madAsHell said...

you forgot the "palpitating your testicles " part.


aaahhh.....are you sure that he's not just playing with you?

Seeing Red said...

War on Wymin!!

Or now we play count the tests we don't need to cut Obamacare costs!

Seeing Red said...

With all the STDs, now they decide to cut back? Well Wymym do live longer and cost more.....

Skyler said...

I've been noticing a lot of reports and news articles lately telling us that we don't need doctors or medical exams anymore. This is the precursor to the death panels.

When health care is provided by the people/government, then the people/government decide how much you get and how much they'll pay for.

FullMoon said...

When I see my dentist, I will ask her about that penile examination.

Regarding prostate exam, ask you gp to refer you to a young female proctologist.I did.

Freeman Hunt said...

One large, hospital OBGYN clinic in this area dismissed all of its male doctors and nurses and allows only women to practice there. Not sure why the clinic hasn't been sued for sex discrimination. Seems plainly illegal.

Deirdre Mundy said...

Paul--- I've had both male and female OB/GYNS (moved a lot.) I look at a doctor's philosophy, credentials, and personality. In other words, I want a skilled doctor who I won't want to punch.

Sometimes, the best available doctor has been male, sometimes female.

I do tend to avoid YOUNG doctors. They tend to think they know more than they actually do, and they're really irritating when you're in labor.

Mark said...

If you like your pelvic exams, you can keep your pelvic exams.

Bruce Hayden said...

I've always wondered why women chose male doctors in this day and age.

My understanding, from a limited survey, is that some women prefer women looking down there, and some women prefer men to do it. I have asked before if the latter is due to a bit of latent homophobia (and got hit for it).

Why would women pick male doctors (other than Ob/Gyns)? One answer is that men and women react differently to different people. I don't think that my partner really like women, and I think that a lot of women don't like her. She strongly bonds with her male doctors, but doesn't do well with her female doctors. Remember one practice where the MD running it (a male) was fine with her, but she mostly got the female PA, and that didn't go well at all. Switched to a new practice, where she deals with the male doctor, and I deal with the female office staff. That works great.

CatLover said...

Lest we forget. Doctors frequently make money on tests.

Bruce Hayden said...

One large, hospital OBGYN clinic in this area dismissed all of its male doctors and nurses and allows only women to practice there.

Not surprised, really. There has long been a desire by a lot of women for their ob/gyns to be women. And, the problem with having men in the practice may be that a lot of practices require that the women expecting babies rotate through the gynecologists in the practice, because any one of them may be on call the day that their baby comes. And, it is apparently much more efficient, all around, if the on-call ob does most of the deliveries the day that they are on-call.

That reminds me of the practice that the mother of my kid was utilizing at the time that my kid was born. College town had two female obs, one experienced (ours), and one other. Our ob was in a practice with a bunch of men, but got a lot of patients of an Islamic persuasion, due to the university in town. She thought the religion, and esp. the men bringing their wives to her, were the ultimate sexists, and so made them rotate through all the male obs during pregnancies, and had a rule of never delivering their babies if not on her on-call days.

This doctor, Ann's age, would tell stories about the level of hazing that she got breaking into the field. Obstetrics is surgery, and thus the doctors in the field were pretty macho. A lot of them, esp. the older ones, apparently didn't take well to women entering into their field. Oh well. So sad. With slightly more women than men graduating from med school these days, and likely a bit more women preferring female ob/gyns than men, these male doctors were ultimately going to lose this debate.

Which is how, I think, that the practice that Freeman mentioned would survive a legal challenge to their female-only practice. Female patients who insist on only being seen down there by female staff would screw up on-call and rotations with male doctors involved. The former would likely cause the female doctors to have to deliver more babies on their non-on-call days. Which would mean more late night and early morning trips to the hospital than their male colleagues would have (on days when they had full schedules of office visits planned). I would think that this would, thus, be a major accommodation, not a minor one, and thus able to potentially survive legal review. Just a theory, of course.

Bruce Hayden said...

If you like your pelvic exams, you can keep your pelvic exams.

Maybe, and maybe not. Which I am sure is why you made the snark.

But, it will be interesting to see how well they survive ObamaCare rationing. On the one hand, they do involve women, and #WarOnWomen, etc. Meaning that we have already seen HHS and the Administration skew health care in women's direction with the contraception mandate. On the other hand, maybe significant money can be saved by reducing the frequency of pelvic exams and mammograms.

One of the things though to keep in mind is that there are a lot of counter-intuitive things in medical treatments. Sometimes, the more expensive treatment actually does save money long term. And, sometimes not. When looking for efficient versus inefficient treatments, you need to look for both positive and negative correlations - negative statistical correlation often indicating that the more expensive treatment option is the more efficient.

Beach Brutus said...

Next week I bet this same author will publish a piece boosting more dollars for preventive medicine -- the heart of which is these types of examinations, and notice the contradiction.

Beach Brutus said...

... and NEVER notice the contradiction.

James Pawlak said...

1. You are welcome to exercise your right to refuse a pelvic exam. But,please inform me of your insurance carriers so as to allow me to insure none of my investments are with them.
2. "Please turn you head to one side and cough"--A phrase well known to men.

Carol said...

rightguy, isn't the Pap test appropriate only for someone who could have gotten hpv?

Some of us are waaay past that stage.

YoungHegelian said...

Once, years ago, I had really nasty gut pains at work. The building nurse (it was a government site) feared I had appendicitis and immediately sent me to a nearby hospital emergency room.

Well, they poked & prodded me and determined that I just had some nasty form of non-specific gastroenteritis. At the end of it all, they sent a young nurse to tell me I could dress & go home. Well, she stood there as I dressed, looking like a deer in headlights. I had to tell her "Miss, would you mind closing the curtain?", which she did, while continuing to stand there. She stood there until I dressed & left.

I have no idea what that was about. I was a younger man then, & not unpleasant to look at, but it's not like I was ever built like a porn star, in any of my dimensions. I just figured if my bare ass broke the monotony of her day, well, all-righty then.

jr565 said...

Show me your genitals, your genitals
Show me your genitals
Your GENITALIA!

jr565 said...

Doc I came for the flu shot, why are you stroking my balls?

~ Steven said...

I'm not sure that you can rely upon papers advocating less is more when it comes to health care since the peer review system (at least in part) is broken.

http://online.wsj.com/articles/hank-campbell-the-corruption-of-peer-review-is-harming-scientific-credibility-1405290747?source=science20.com

JM Hanes said...

Hess asserts that the FDA "voted to replace the pap smear… with an HPV test…" Not exactly, but never mind.

She seems unaware that both exams require cervical cell material for screening -- in other words, the collection procedure she ascribes to pap smears is presumably required for HPV testing too. If I'm not mistaken, the salient difference comes ex post facto at the lab, with microscopic screening in the first instance vs DNA screening in the second.

This mix of pop-psyche conjecture and dowdified research reporting has become as tedious as it is ubiquitous. In this case it includes a veritable mental health mashup on both sides of the putative question, pitting postulated (potential!) emotional discomfort against the postulated benefits of (potentially!) turning doctors into nannies. Sheesh.

If the subject is nightmarish consequences, just imagine comparative effectiveness research with (potentially!) indelicate side effects tacked onto already problematic medical decision making criteria.

JM Hanes said...

Paul: "I suggest women go to more women doctors and men to male doctors."

Speaking for myself (and aren't we all?), I put recommendations and a face to face visit at the top of my list, with gender close to last. A lot of people don't really have the luxury of choice, whether it's the prohibitive expense of shopping around, the availability of local practitioners, or their willingness to take on new patients. It is not helpful to describe (imagine!) a woman's pelvic exam as "messing with her." In my experience, such exams have always been a combination of discreetly draped sheets, a doctor who is polite and professional, accompanied by a nurse in the examination room.

I can certainly understand why some women might prefer a female gynecologist for intrusive procedures and that men might have understandable concerns about embarrassing arousal, but the implication that there's something basically untoward about male practitioners treating female patients (or women treating men) is really unfair to doctors. It also effectively constrains the choices that many of both sexes might otherwise be sufficiently comfortable making, and adds another layer of gratuitous anxiety, when a doctor of the opposite sex is the only available option.

Michael K said...

The ACP is the outfit that helpfully explained that the Hippocratic Oath was obsolete.

" the Government's meddling in the Medical industry for the last 50 years is actually the cause of much of the increase in medical costs."

Exactly. When I was a child in the 1950s, doctors were middle class and health insurance paid for insurable events like heart attacks and appendicitis. I was part of organized medicine for 30 years and warned colleagues that this would come back to bite us.

Here is the bite and it is big. I wouldn't trust the AMA if it said the sun rose in the East. They sold out years ago. The Democrats were smarter than Hillary was. This time they bought off the insurance companies.

It's still not going to work.

Kirk Parker said...

betamax3000 @ 9:12 AM,

Well.... is she hot???

Kathy said...

I have a male on/gyn. I chose him based on recommendations. I stayed as his patient because he's professional and cautious and he delivers his patients' babies even if he's not on call.

a psychiatrist who learned from veterans said...

Maybe there was no 'adequate and well controlled study that treating syphilis with PCN' led to lowering of mortality. That didn't stop the study that didn't treat black men known to have it, the Tuskegee study, from being considered unethical and to lead to a huge uproar and the Belmont report saying you couldn't do such a thing. To the point of the issues here, you're not going to find a pap smear that leads to further investigation and possibly saving someone from cervical cancer if you don't do one.

David Hampton said...

Recent article stated that there is an increase in throat cancer from oral sex on your female partner due to the presence of malignant cells in the vagina tissue. As stated in a prior post, identifying STD's on male and females saves lives. In this day and age where feminists want women to be a licentious in their behavior as men, being equal and all, the necessity for pelvic exams is a worthwhile endeavor. Lack of restraint in males regarding their relations with females and females being encouraged to express their freedom from the clutches of modesty is all the more reason to receive comprehensive exams to prevent the spread of disease, infertility caused by abortions, and increased risk of various cancers from "hooking up" sex. Gives new meaning to the phrase "pay to play." The old virtues of modesty and restraint were correct for a reason.