Imagini pentru Many young women get unnecessary pelvic exams

Although guidelines say most women under age 21 don’t need pelvic exams or cervical cancer screenings, a U.S. study suggests many still get these invasive tests.

Nationwide, an estimated 1.4 million such women get potentially unnecessary pelvic exams and an estimated 1.6 million get cervical cancer screenings they may not need, researchers report in JAMA Internal Medicine.

Needless tests “can lead to false alarms, unnecessary treatment, and needless cost,” said study leader Jin Qin of the U.S. Centers for Disease Control and Prevention in Atlanta.

“Many young women associate the examination with fear, anxiety, embarrassment, discomfort and pain,” and some of them “may forgo contraception or sexually transmitted infection (STI) screening because of psychological stress associated with these exams, which could lead to unintended pregnancies and may increase overall health risks, “Qin said by email.

Cervical cancer screening, done by placing an instrument into the vagina to scrape cells from the cervix, isn’t recommended for women under 21 under guidelines from the U.S. Preventive Services Task Force, the American College of Obstetricians and Gynecologists and the American Cancer Society.

Pelvic exams, which typically involve inserting a speculum to widen the vagina and visually examine the cervix as well as a manual internal exam of the reproductive organs and rectum, aren’t recommended for asymptomatic women who aren’t pregnant.

Young women and parents of teens should know that prescribing most contraceptives and testing for many STIs doesn’t require pelvic exams or cervical cancer screening, the researchers note.

For the study, they examined national survey data collected from 3,410 women ages 15 to 20 between 2011 and 2017.

About 23% women reported having a manual internal pelvic exam in the previous year, translating into approximately 2.6 million young women nationwide.

More than half of these pelvic exams – about 54% – did not appear to have medical reasons like pregnancy, STI symptoms or use of an intrauterine contraceptive device (IUD). This means approximately 1.4 million teens and young women may have had unnecessary exams.

In addition, about 19% of the women said they had cervical cancer screening with a Pap test in the previous year, translating into 2.2 million nationwide. Pap tests are only recommended for a small minority of women under 21 who are HIV-positive and sexually active, suggesting most of these tests were also unnecessary.

“Recommendations and guidelines have evolved over time,” Qin noted. “Prior to 2012, guidelines recommended starting cervical cancer screening at or around onset of sexual activity or age 21, whichever came first. In 2012, recommendations from major organizations agreed that the initiation age (should) be 21 years regardless of sexual behaviors and risk factors. Leading professional organizations have issued or updated their recommendations regarding pelvic examination since 2014, recommending against pelvic examination among women who are not pregnant or have no symptoms.”

However, she added, “many healthcare professionals still believe that the pelvic examination is a useful tool to screen for gynecologic cancers, contrary to guideline recommendations.”

Even when women don’t think they need pelvic exams or Pap tests, they should still get annual checkups, said Dr. Melissa Simon of the Northwestern University Feinberg School of Medicine in Chicago, who wrote a commentary accompanying the study.

Women should ask questions before consenting to these tests and consider switching providers if they’re told they can’t get birth control without a pelvic exam, Simon said by email.

“In the absence of any symptoms or other diseases such as being immunocompromised – like having HIV, AIDS or cancer) – a pap test is not needed prior to age 21,” Simon said.

“Also, a pelvic exam is not needed,” Simon added. “And, neither a pelvic exam nor a pap test is needed in order to obtain contraception, except in the case (of) an IUD.”



Addiction can manifest in a lot of ways, whether it’s drugs or alcohol, shopping, or even food. But new research says the emotion that underlies addiction may be the most notable factor as far as what triggers addictive behavior in the first place.

Many have wondered about exactly that—how emotion correlates with addiction. Which is why a team of Harvard researchers conducted four interwoven studies to identify the root of the problem.

To conduct their research, the team did separate analyses on various research studies. They looked at lab tests that examined how smokers respond to negative emotions, a study on how deeply and often people smoked cigarettes, and more, and all of it pointed to sadness as the strongest influence to smoke.

Looking at the data.

In a national longitudinal survey of over 10,000 people, the sadder the survey participants were, the likelier they were to smoke and even relapse a decade or more after quitting. In another, 425 smokers watched different video clips and wrote about personal experiences. The participants who had to watch a sad video had higher cravings to smoke than participants who watched a neutral or repulsive video.

The third study had 700 participants also watch videos and write about life experiences. Then they were given the hypothetical choice of fewer cigarette puffs sooner, or more, later. Those who watched the sad video, as you might have expected, were more impatient to smoke.

And lastly, the fourth survey involved sad videos again, but this time the participants hadn’t smoked in eight hours. After watching their videos, the group who watched the sad video smoked through a device that tested the volume of puffs, as well as speed and duration. The group who watched the sad video were found to smoke more aggressively, taking deeper puffs.Article continues below

A new perspective on addiction.

The team’s lead researcher, Charles A. Dorison, notes that these findings offer a novel perspective on the underlying cause of addictive behavior.

“The conventional wisdom in the field was that any type of negative feelings, whether it’s anger, disgust, stress, sadness, fear, or shame, would make individuals more likely to use an addictive drug,” he says. “Our work suggests that the reality is much more nuanced than the idea of ‘feel bad, smoke more.’ Specifically, we find that sadness appears to be an especially potent trigger of addictive substance use.”

With that in mind, the team hopes this knowledge will help those suffering from addiction understand their behavior, and hopefully, change it.

Combating sadness.

Jennifer Lerner, Ph.D., senior co-author of the research, says the findings could have positive effects on public health policy surrounding addiction, such as reframing substance abuse ads to avoid triggering sadness.

Dorison adds, “We believe that theory-driven research could help shed light on how to address [the addiction] epidemic. We need insights across disciplines, including psychology, behavioral economics and public health, to confront this threat effectively.”

As far as how to mitigate sadness in general, well, wouldn’t we all like to know?

There are lots of ways to invite happiness into your life, but often focusing on achieving happiness can actually have the opposite effect. Instead of dwelling on a lack of happiness, which only highlights sadness, we’d be better off to focus on wholeness and accepting where we are.

Mindfulness can be a great tool to overcome sadness and addictive behavior, too. And if you or someone in your life is struggling with addiction, know recovery is possible.


Children born to mothers who consumed at least 360 mg caffeine per day during pregnancy are more likely to have a higher BMI and greater total body, abdominal and liver fat masses compared with children born to mothers who consumed 90 mg or less caffeine per day, according to findings from a population-based study.

“Our study shows that high maternal caffeine intake during pregnancy is related to increased adiposity in the children of these mothers,” Romy Gaillard, MD, PhD, assistant professor in the department of pediatrics, Erasmus MC University Medical Center in Rotterdam, Netherlands, told Healio. “The children of mothers with a high caffeine intake during pregnancy had a higher childhood BMI and more total body fat, abdominal fat and liver fat, as compared to children of mothers who consumed a low amount of caffeine during pregnancy.”

Gaillard and colleagues analyzed data from 4,770 mothers and children participating in Generation R, a prospective, population-based study from early pregnancy onward in Rotterdam. Researchers assessed maternal caffeine intake during pregnancy via questionnaires and childhood fat mass via DXA at age 10 years. To calculate total caffeine intake for each trimester, researchers weighed type of coffee or tea according to caffeine content (caffeinated coffee = 1; caffeinated and decaffeinated coffee = 0.5; decaffeinated coffee = 0; caffeinated tea = 0.5; caffeinated and decaffeinated tea = 0.25; decaffeinated tea = 0; herbal tea = 0; and green tea = 0.5). Each unit of caffeine intake reflected caffeine exposure based on one cup of caffeinated coffee (90 mg caffeine). Total daily caffeine intake was stratified as less than 2 U, 2 U to 3.9 U, 4 U to 5.9 U and at least 6 U per day.

Cup of Coffee

 Children born to mothers who consumed at least 360 mg caffeine per day during pregnancy are more likely to have a higher BMI and greater total body, abdominal and liver fat masses compared with children born to mothers who consumed 90 mg or less caffeine per day.Source: Shutterstock

Within the cohort, 58.3% of women consumed less than 2 U caffeine daily, 33.2% consumed between 2 U and 3.9 U, 6.9% consumed between 4 U and 5.9 U and 1.6% consumed at least 6 U caffeine daily.

Researchers found that the children of mothers who consumed between 4 U and 5.9 U caffeine daily had a higher BMI compared with the children of mothers who consumed less than 2 U caffeine per day (mean difference, 0.12 standard deviation [SD]; 95% CI, 0.01-0.24), as well as greater total body fat mass index (mean difference, 0.14 SD; 95% CI, 0.04-0.25) and greater android/gynoid fat mass ratio (mean difference, 0.16 SD; 95% CI, 0.05-0.27). Similarly, compared with the children of mothers who consumed less than 2 U caffeine per day, children of mothers who consumed at least 6 U caffeine per day had a higher BMI (mean difference, 0.24 SD; 95% CI, 0.01-0.47), greater total body fat mass index (mean difference, 0.22 SD; 95% CI, 0.02-0.43) and greater android/gynoid fat mass ratio (mean difference, 0.22 SD; 95% CI, 0.01-0.44).

he children of mothers who consumed at least 6 U caffeine daily were also more likely to have overweight or obesity at age 10 years compared with the children of mothers who consumed 2 U or less per day (OR = 1.59; 95% CI, 0.92-2.75). All results persisted after adjustment for gestational age at birth and birth weight, and associations were similar across pregnancy.

Children of mothers who consumed between 4 U and 5.9 U caffeine daily also had higher liver fat fraction when compared with the reference population (mean difference, 0.2 SD; 95% CI, 0.04-0.36).

“From previous studies, it is already known that mothers who consume a high amount of caffeine during pregnancy have a higher risk of adverse birth outcomes, such as delivering newborns with a low birth weight,” Gaillard said. “Based on these observations, current guidelines already advise pregnant women to limit their caffeine intake to 200 to 300 mg per day during their pregnancy. The findings in our current study support these current guidelines and show that high maternal caffeine intake during pregnancy, above the recommended amount, is not only related to adverse birth outcomes, but also related to increased childhood fat levels in the offspring.” – by Regina Schaffer

For more information:

Romy Gaillard, MD, PhD, can be reached at the Generation R Study Group, Erasmus MC, University Medical Center, P.O. Box 2040, Rotterdam, 3,000 CA, Netherlands; email:

Disclosures: The authors report no relevant financial disclosures.


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