Does Your Teen Daughter Need Routine Pelvic Exams & Pap Tests?
Your teen's first trip to the gynecologist can feel like a major, albeit often nerve-wracking milestone. But according to new estimates from researchers at the University of California San Francisco and the Centers for Disease Control and Prevention, far too many patients between 15 and 20 are being subjected to unnecessary exams at these visits. Here's what parents and patients in this age group need to know.
GYN Exams a Teen Should Have—& Not Have
Almost 11 years ago, the American College of Obstetricians and Gynecologists (ACOG) issued a committee opinion stating that most patients under the age of 21 don't need pelvic exams. (The exam involves a doctor inserting two gloved fingers into the vagina to check for abnormalities or infection, as well as placing a speculum into the vagina, which allows the physician to look inside the vagina and cervix.)
If as a patient is having abnormal bleeding, pain, is unable to insert a tampon, is pregnant, or is getting an IUD, they might be a candidate for a manual exam. Otherwise, these exams are often lead to "false-positive test results, over-diagnosis, anxiety, and unnecessary costs" for most people in this age group.
And when it comes to Pap tests, which screen for cervical cancer, ACOG doesn't recommend routine screenings until a patient is 21. And then, patients aged 21–29 years are advised to have a Pap test every three years.
So, what exams are recommended for 15- to 20-year-olds? A general physical exam and an external genital exam, according to ACOG. If a patient is sexually active, they might be screened for certain STIs, but most tests teens need can be done with a urine sample. They might also get vaccinations, like the the HPV vaccine (Gardasil 9), which currently recommended for girls and women age 9 to 26.
What the Researchers Found
UCSF and CDC researchers analyzed survey data from the National Survey of Family Growth from 2011 to 2017, sourced from 3,410 girls and young women aged 15 to 20. Only 4.5% of respondents reported STI treatment, just 4.8% reported pregnancy, and 2% reported IUD use within a 12-month period. Yet, during the same time frame, about 2.6 million girls and young women in the same age bracket reported having received a pelvic exam, and 2.2 million said they’d received Pap tests.
The study, published in JAMA Internal Medicine, concluded 54.4% of those exams and 71.9% of those pap tests may have been unnecessary. The authors concluded, "The results suggest that compliance with the current professional guidelines regarding the appropriate use of these examinations and tests may be lacking."
Felice Gersh, M.D., a board-certified obstetrician and gynecologist and author of PCOS SOS Fertility Fast Track, who did not work on the study says that routine pelvic exams simply aren't called for in this group, given the "remote" chances that a physician would find anything pathological in a patient of that age who is experiencing no symptoms.
At the same time, it can be upsetting and uncomfortable. "The chance that you'll traumatize her by the invasive process of examining the insides of her vaginal canal, her cervix, while also using hands and fingers to palpate her reproductive organs, far exceeds the remote chance of potential benefits," says Dr. Gersh.
She recommends that young patients who are not sexually active and have no symptoms should "absolutely" let their gynecologist know that they do not wish to undergo pelvic exams and Pap tests.
That said, patients in this age group who are sexually active should receive safe sex counseling, contraceptive counseling and options, and counseling for any concerns regarding their menstruation or reproductive health, notes Mia Di Julio, MD, OB-GYN at Providence Saint John’s Health Center in Santa Monica, California. Dr. Di Julio also echoes ACOG's position on pelvic exams for sexually active 15- to 20-year-olds: "Pelvic exams may be necessary in someone who is symptomatic or pregnant. Examples include evaluation of painful or frequent menses and evaluation for potential infections."
In either case, and whether or not they're with them inside the exam room, parents can support their kid's bodily autonomy and give them the space to voice what they want—and do not want—out of the visit.
How to Prevent Unnecessary Exams
While speaking up and refusing to be bullied are skills teens frequently hone in the classroom or while socializing with peers, these findings make clear that they'll do well to put them to use in an exam room, as well. While this new research will hopefully serve as a wake-up call for physicians who've been performing pelvic exams and Pap tests unnecessarily, it's also a reminder that patients, of all ages, often must advocate for themselves.
As Dr. Di Julio puts it, "Both doctors and patients’ expectations and comfort with guideline changes often take time. Additionally, there are some clinical scenarios that can fall outside the situations detailed by guidelines. This is where combined decision making between the patient and doctor becomes even more important. All patients should discuss the rationale of exams and interventions with their doctor during their visits."