The American College of Physicians (ACP) recently issued new clinical practice guidelines recommending against annual pelvic examination in asymptomatic, nonpregnant women at average risk for gynecologic conditions such as cancer and pelvic inflammatory disease. The new guidelines only address the speculum and bi-manual portions of the examination.
The annual pelvic examination has long been considered a standard component of preventive care for healthy women. However, after reviewing nearly 70 years of evidence, the ACP determined that screening pelvic examination is unnecessary because there is no evidence of benefit and some low-quality evidence of potential harm such as overdiagnosis, overtreatment, and increased patient anxiety.
The new ACP guidelines are good news for the many women who find screening pelvic examination unpleasant or painful. However, it is too soon to know how these guidelines will actually influence clinical practice, particularly since the American College of Obstetricians and Gynecologists (ACOG) continues to recommend annual pelvic examination for all women over the age of 21 years. ACOG acknowledges a lack of evidence to support the benefits of screening pelvic examination, but disagrees with the ACP on the importance of this finding, stating that, “While not evidence-based, the use of pelvic exams is supported by the clinical experiences of gynecologists treating their patients.”
The annual pelvic examination typically includes an inspection of the external genital and anal area, a visual examination of the vagina and cervix with the aid of a speculum, the collection of cervical swabs, and a bi-manual examination of the uterus, cervix, and ovaries. The cervical swabs are collected for a Papanicolaou (Pap) smear, which looks for abnormalities in the cervical cells.
The ACP continues to support cervical cancer screening but recommends that it be limited to a visual examination of the cervix and the collection of cervical swabs for cancer and human papillomavirus (HPV) testing. The ACP statement avoids recommendations regarding the frequency of cervical cancer screening.
- Qaseem A, Humphrey LL, Harris R, Starkey M.; Clinical Guidelines Committee of the American College of Physicians. Screening pelvic examination in adult women: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2014;161(1):67-72. Available at: http://annals.org/article.aspx?articleid=1884537. Accessed July 7, 2014.
- Bloomfield H, Olson A, Greer N, et. al. Screening pelvic examinations in asymptomatic, average-risk adult women: an evidence report for a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2014;161(1):46-53. Available at: http://annals.org/article.aspx?articleid=1884533. Accessed July 7, 2014.
- American Congress of Obstetricians and Gynecologists (ACOG). ACOG Practice Advisory on Annual Pelvic Examination Recommendations [news release]. June 30, 2014. Available at: http://www.acog.org/About-ACOG/News-Room/College-Statements-and-Advisories/2014/ACOG-Practice-Advisory-on-Annual-Pelvic-Examination-Recommendations. Accessed July 7, 2014.