ACOG, AAFP & USPSTF Guidance: Still a Role for the Annual Pelvic Exam?
Learning Objectives and CME/Disclosure Information
This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. Restate the outcome measures discussed in the USPSTF evidence report and summary review 2. Discuss the components of a well woman visit according to ACOG
Estimated time to complete activity: 0.25 hours
Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.
The PIM planners and others have nothing to disclose. The OBG Project planners and others have nothing to disclose.
Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
Method of Participation and Request for Credit
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from Dec 31 2017 through Jan 25 2023, participants must read the learning objectives and faculty disclosures and study the educational activity.
If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.
For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.
Joint Accreditation Statement
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physician Continuing Medical Education
Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.
In March 2017, the USPSTF released its Evidence Report and Systematic Review on the topic of periodic pelvic exams. The main outcome measures were morbidity, mortality, harms caused by misdiagnoses and diagnostic inaccuracy for gynecologic cancers and conditions. Cervical cancer and STDs were not included as they were already covered in previous evidence assessments. The summary conclusion states
No direct evidence was identified for overall benefits and harms of the pelvic examination as a 1-time or periodic screening test. Limited evidence was identified regarding the diagnostic accuracy and harms of routine screening pelvic examinations in asymptomatic primary care populations.
ACOG released updated guidance, replacing the prior committee opinion, which provides an overview of the well-woman visit. ACOG recommends that a comprehensive history should guide aspects of the physical exam, such as breast and pelvic examination. In other words, physical exam should be viewed in terms of a comprehensive provider-patient encounter.
The summary recommendations and conclusions include the following
A well-woman visit provides an excellent opportunity to counsel patients about maintaining a healthy lifestyle and minimizing health risks.
The periodic well-woman care visit should include screening, evaluation and counseling, and immunizations based on age and risk factors.
The interval for specific individual services may differ for individual patients, and the scope of services provided may vary in different ambulatory care settings.
Team-based care, including obstetrician–gynecologists, physician assistants, nurse practitioners, and other health care professionals, may facilitate meeting the needs of preventive care for women.
Comprehensive ‘Well-Woman’ History
When taking a history, obtain the following
Symptoms, if any
Mental health (use screening tools as appropriate)
Medications and allergies
Family history (screening tools available – see ‘Related ObG Topics’ below for more information)
Pelvic and Breast Examinations
Perform pelvic and breast examinations based on above history and/or symptoms
Assess for the presence of
Poor nutrition/dietary habits
Limited physical activity
The above risk factors contribute to CVD, diabetes and malignancies
Counsel regarding lifestyle choices and potential impact and overall and reproductive health
ACOG has an obesity toolkit (see ‘Learn More – Primary Sources’ below)
Discussion of Reproductive Life Plan
A discussion of a reproductive life plan can include
The well-woman visit can be used to discuss issues surrounding perimenopause and postmenopause
Other Professional Recommendations
AAFP in April 2017 released a Clinical Preventive Service Recommendation against screening pelvic exams in asymptomatic women, giving it a Grade D. AAFP acknowledges that their recommendation differs from the USPSTF. The guidance states the following
The USPSTF’s review did not include screening for ovarian cancer, cervical cancer, gonorrhea, or chlamydia, as these are already covered by other USPSTF recommendations. Yet malignancy and pelvic inflammatory disease are the leading gynecologic causes of morbidity and mortality in women. Screening for other conditions that have limited effect on morbidity or mortality are unlikely to provide substantial benefit. There is evidence of harms for performing screening pelvic exams in asymptomatic women due to the increased risk of invasive testing and unnecessary treatment.
The SOGC in August 2019 released evidence-based guidance and similar to ACOG, recommends taking in to account history and physical when assessing the role of pelvic examination. Furthermore, the SOGC guidance states that
No study published to date has adequately evaluated any component of the pelvic examination as a screening method for any type of malignant gynaecologic disease, except for the speculum examination for cervical cancer cytology screening. As such, any universal recommendations for or against pelvic examinations for other indications can only be made based on expert opinion and low-quality evidence
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Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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