These dueling recommendations leave women in the unenviable position of sorting out what to do.

The uncertainty echoes the ongoing debate about whether women need mammograms annually or every two years. The decision about the pelvic exam may get easier in the coming months, if the U.S. Preventive Services Task Force, which is weighing the evidence, makes a recommendation. The recommendations from the task force, a volunteer advisory group of medical experts, help govern what is covered without a co-pay under the Affordable Care Act. A yearly “well-woman” visit, which may include a pelvic exam, is among the services covered under the health law.

The debate over the pelvic exam exemplifies the thorny process of distinguishing effective care from that deemed by some experts to be “low-value,” an issue facing all specialties as medicine becomes increasingly evidence-based. The controversy also underscores the difficulty of changing long-established clinical practice and raises questions about the role of reimbursement in shaping physician behavior.

“This is about what you believe might be helpful,” said Judy Norsigian, the former executive director of the Boston Women’s Health Collective and a co-author of Our Bodies Ourselves, the groundbreaking feminist health book first published by the group in 1970. “Everyone brings into this decision their values and concerns about the medical system,” and must weigh the risk of overtreatment against the failure to detect something important. “The question is: Which risk do you want to take? Women have very different views on this.”

To George Sawaya, a professor of obstetrics and gynecology and epidemiology and biostatistics at the University of California at San Francisco School of Medicine, “The question is: What should we be doing in that well-woman visit?” He regards the routine exam as “more of a ritual than an evidence-based practice.” A 2013 study he co-authored found that many gynecologists erroneously believe the exam effectively screens for ovarian cancer. It doesn’t; in fact, no effective screening method exists. And Sawaya’s team found that among the reasons doctors do pelvic exams is to “ensure adequate compensation” for routine gynecological care and because patients expect it.

But Barbara Levy, ACOG’s vice president for policy, said that clinical, not financial, concerns are the driving force. Gynecologists, Levy said, are “trying to provide the best service for patients that we can.” In Levy’s view, the ACP guidelines are misguided. “A lack of evidence does not equal lack of benefit,” she said.

* * *

Until recently, the annual pelvic exam, performed along with a Pap smear, a test that analyzes cells to screen for cervical cancer, was sacrosanct. But in 2009, the Pap recommendation was revised, after studies showed that most healthy women between 21 and 65 could wait three to five years after a normal Pap test before having another. After 65, most could stop getting a Pap test altogether.