Pelvic exams and Pap tests not necessary in young women: JAMA

USA: A recent analysis found that more than half of the bimanual pelvic examinations and about 70% of Pap tests performed on young women aged 15 to 20 years in the US are potentially necessary, and exposes them to preventable harms. Results of the study, published in JAMA Internal Medicine, suggests that there is a lack of compliance with the current professional guidelines regarding the appropriate use of these examinations and tests.

Cervical cancer screening is no longer recommended for women younger than 21 years. Also, the pelvic examination is not recommended for asymptomatic, nonpregnant women and may cause harm such as false-positive test results, overdiagnosis, anxiety, and unnecessary costs.

Jin Qin, Centers for Disease Control and Prevention, Atlanta, Georgia, and colleagues estimated the prevalence of potentially unnecessary BPE and Papanicolaou (Pap) tests performed among adolescent girls and women younger than 21 years in the US and to identify factors associated with receiving these examinations.

For the purpose, the researchers conducted a cross-sectional analysis of the National Survey of Family Growth from September 2011 through September 2017 focused on a population-based sample of young women aged 15 to 20 years (n = 3410). Survey weights were used to estimate the prevalence and the number of people represented in the US population.

The main outcomes and measures were receipts of a BPE or a Pap test in the last 12 months and the proportion of potentially unnecessary examinations and tests.

Read Also: Annual Pap Test ‘Thing of the Past’ : New USPSTF recommendation

Key findings of the study include:

• Among US young women aged 15 to 20 years represented during the 2011-2017 study period, 4.8% were pregnant, 22.3% had undergone STI testing, and 4.5% received treatment or medication for an STI in the past 12 months.


• Only 2.0% reported using an IUD, and 33.5% used at least 1 other type of hormonal contraception in the past 12 months.


• Among US young women aged 15 to 20 years who were surveyed in the years 2011 through 2017, approximately 2.6 million (22.9%) reported having received a BPE in the last 12 months.


• Approximately half of these examinations (54.4%) were potentially unnecessary, representing an estimated 1.4 million individuals.


• Receipt of a BPE was associated with having a Pap test (adjusted prevalence ratio [aPR], 7.12), testing for sexually transmitted infections (aPR, 1.60), and using hormonal contraception other than an intrauterine device (aPR, 1.31).


• An estimated 2.2 million young women (19.2%) reported having received a Pap test in the past 12 months, and 71.9% of these tests were potentially unnecessary.

"These findings suggest the need for education for health care professionals, parents, and young women themselves to improve awareness of professional guidelines and the limitations and harms of routine pelvic examination and Pap test and to ensure that these tests and examinations are performed only when medically necessary," concluded the authors.

The study, "Prevalence of Potentially Unnecessary Bimanual Pelvic Examinations and Papanicolaou Tests Among Adolescent Girls and Young Women Aged 15-20 Years in the United States," is published in JAMA Internal Medicine.

DOI: https://doi.org/10.1001/jamainternmed.2019.6291