Practice Guidelines

ACP Provides Guidance on Screening Pelvic Examination in Women

 


FREE PREVIEW. AAFP members and paid subscribers: Log in to get free access. All others: Purchase online access.


FREE PREVIEW. Purchase online access to read the full version of this article.

Am Fam Physician. 2015 May 15;91(10):732.

Key Points for Practice

• Screening pelvic examination should not be performed in asymptomatic, nonpregnant women.

• Possible harms include fear, anxiety, deterring some women from getting medical care, and false-positive results leading to unnecessary laparoscopies or laparotomies.

• Pelvic examination should not be performed for sexually transmitted infection screening; urine or vaginal swab testing is sufficient.

• Screening pelvic examinations are not needed before prescribing oral contraceptives.

From the AFP Editors

Pelvic examinations, consisting of speculum and bimanual examination for the purpose of this guideline, are often performed in women without symptoms to screen for pathology, including cancer, infection, and pelvic inflammatory disease (PID). However, their accuracy for diagnosing PID, gynecologic cancer (not including cervical or ovarian cancer), and benign conditions has not been addressed in studies, and their accuracy for diagnosing ovarian cancer and bacterial vaginosis is low. Additionally, pelvic examination is associated with many false-positive findings and harms from examination (e.g., unneeded laparoscopies or laparotomies, fear, anxiety).

Routinely performing pelvic examinations increases health care costs, with total yearly cost of preventive examinations, and the related laboratory tests and radiology, in the United States estimated at more than $2.5 billion. This guideline from the American College of Physicians (ACP) provides evidence on the use of pelvic examination to screen for pathology in average-risk, non-pregnant women. This guideline concentrates on screening in women without symptoms; a pelvic examination with bimanual examination may be used in some non-screening circumstances. Additionally, the group due for cervical cancer screening is not addressed in this guideline, but screening should be done by visual inspection of the cervix and cervical swabs, rather than performing a full pelvic examination.

Recommendations

Based on moderate-quality evidence, the ACP makes a strong recommendation that screening pelvic examination should not be performed in asymptomatic, non-pregnant women, with evidence indicating that harms outweigh the benefits of such screening in this population. Low-quality evidence has indicated that pelvic examination screening can lead to harms, possibly preventing some women from getting medical care. False-positive results from pelvic examination can lead to women having unneeded laparoscopies or laparotomies.

High-Value Care

Nucleic acid amplification testing on vaginal swabs or urine has been shown to have high specificity and sensitivity for screening for chlamydia and gonorrhea. Pelvic examination should not be performed for sexually transmitted infection screening; urine or vaginal swab testing is sufficient. Many physicians continue to perform pelvic examination as part of the well-woman appointment; because it is considered to be of low value, it should not be performed in this setting. However, if a woman has symptoms of vaginal discharge, uncharacteristic bleeding, pain, urinary problems, or sexual dysfunction, pelvic examination may be necessary.

Physicians often insist that pelvic examination be performed before providing women with oral contraceptives; this practice does not have evidence to support it, and it is considered to be of low value.

Guideline source: American College of Physicians

Evidence rating system used? Yes

Literature search described? Yes

Guideline developed by participants without relevant financial ties to industry? Yes

Published source: Annals of Internal Medicine, July 1, 2014;161(1):67–72

Available at: http://annals.org/article.aspx?articleid=1884537

Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Sumi Sexton, MD, Associate Medical Editor.

A collection of Practice Guidelines published in AFP is available at http://www.aafp.org/afp/practguide.



 

Copyright © 2015 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions


More in AFP


Editor's Collections


Related Content


More in Pubmed

MOST RECENT ISSUE


Oct 1, 2016

Access the latest issue of American Family Physician

Read the Issue


Email Alerts

Don't miss a single issue. Sign up for the free AFP email table of contents.

Sign Up Now

Navigate this Article