Still No Clear Evidence for Regular Pelvic Exams

March 7, 2017

Still No Clear Evidence for Regular Pelvic Exams

  1. Andrew M. Kaunitz, MD

For asymptomatic nonpregnant women, shared decision-making with their clinicians should determine if pelvic exams are routinely performed.

  1. Andrew M. Kaunitz, MD

Although pelvic examinations are commonly performed as part of well-woman visits, the effect on morbidity and mortality of such examinations in asymptomatic women remains uncertain. To update its guidance, the U.S. Preventive Services Task Force reviewed evidence assessing the benefits and potential harms of pelvic examinations in asymptomatic nonpregnant women not at excess risk for specific gynecologic conditions. This guidance does not address the role of pelvic examinations as part of screening for cervical cancer or sexually transmitted infections.

After identifying a handful of studies, several of which had limited applicability to U.S. gynecologic care, the task force concluded that current evidence is insufficient to recommend for or against routine pelvic examinations.

Comment

The American College of Physicians (NEJM JW Womens Health Aug 2014 and Ann Intern Med 2014; 161:67) and the American Academy of Family Physicians also do not support screening pelvic examinations in asymptomatic women. Although the American College of Obstetricians and Gynecologists recommends annual pelvic exams for women aged 21 and older, ACOG also states that the decision to perform such exams should reflect shared decision-making between the woman and her clinician. In my practice, performing pelvic examinations only for specific reasons (as opposed to routinely) has allowed more time during well-woman visits to address other issues of importance to my patients, enhancing their satisfaction and trust.

Editor Disclosures at Time of Publication

  • Disclosures for Andrew M. Kaunitz, MD at time of publication Consultant / Advisory board Allergan; Bayer AG; Merck; Pfizer Royalties UpToDate Grant / Research support Therapeutics MD; Bayer; Agile; Merck Editorial boards Contraception; Menopause; Contraceptive Technology Update; OBG Management; Medscape OB/GYN & Women’s Health Leadership positions in professional societies North American Menopause Society (Board of Trustees)

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