For Physicians. By Physicians.™
For Physicians. By Physicians.™
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.
When taking a history, obtain the following
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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