This Practice Advisory replaces the one released on March 7, 2017. It clarifies the evidence reviewed by the U.S. Preventive Services Task Force.
On March 7, 2017, the U.S. Preventive Services Task Force (Task Force) released a final recommendation statement and evidence summary on screening for gynecologic conditions with pelvic examination in women without any signs or symptoms. The Task Force’s recommendation is an "I" statement; that is, it concluded there is not enough evidence to determine the balance of benefits or harms of performing screening pelvic exams (external inspection, internal speculum examination, bimanual examination, and rectovaginal examination) in asymptomatic, non-pregnant adult women. This is not a recommendation against performing a routine pelvic examination; it encourages continued use of clinical judgment and is a call for more research.
The Task Force identified a limited number of studies on the accuracy of a screening pelvic examination for a range of gynecologic conditions and was only able to evaluate the evidence on four specific conditions: ovarian cancer; bacterial vaginosis; genital herpes; and trichomoniasis. Studies addressing other conditions are currently lacking. This Task Force recommendation applies to non-pregnant, asymptomatic women. The Task Force has already issued strong recommendations in support of screening for cervical cancer, gonorrhea, and chlamydia. The benefit of using pelvic examination alone to screen for gynecologic conditions other than cervical cancer, gonorrhea, and chlamydia is unknown.
The American College of Obstetricians and Gynecologists (the College) is reviewing the Task Force’s recommendation statement and the evidence upon which it is based to evaluate the need to update the College’s guidance on the routine pelvic examination.
What The Task Force Recommendation Means
More research is needed, as indicated by the Task Force's "I" statement for insufficient evidence. As noted in the College's Committee Opinion #534, "Well-Woman Visit," current recommendations on the pelvic examination are based on expert opinion. Research is needed to determine if there is value related to the performance of a screening pelvic examination for conditions other than cervical cancer, chlamydia, and gonorrhea.
There are some women who may benefit from a screening pelvic examination depending on their individual health condition and information shared during the encounter.
What The Task Force Recommendation Does NOT Mean
The "I" statement from the Task Force should NOT be interpreted to mean that a screening pelvic examination should never be performed. It means that there are not enough data to come to a conclusion about whether or not the benefits of performing the exam outweigh any potential risks in asymptomatic women. This is NOT a recommendation that there is no net benefit or that the harms outweigh the benefits (a "D"-grade).
The Task Force recommendation does NOT apply to pregnant women, and it does NOT apply to women who present to their obstetrician-gynecologists with signs or symptoms. This recommendation applies only to asymptomatic, non-pregnant women. It is critically important for obstetrician-gynecologists to elicit accurate and complete medical, surgical, and family histories and to conduct thorough reviews of systems as part of the well-woman visit. Some women may not recognize that certain signs or symptoms are truly abnormal; these signs and symptoms may be interpreted as "normal" for them, when, in fact, they should prompt evaluation, which may include a pelvic examination.
It does NOT mean that women should forgo seeing an obstetrician-gynecologist at least once a year for well-woman care (see http://www.acog.org/wellwoman for recommendations according to age group). This preventive service visit also provides an opportunity for the patient and her obstetrician-gynecologist to discuss whether a pelvic examination is appropriate for her (shared decision making).
More information on the College’s well-women care guidance is available here.
A Practice Advisory is issued when information on an emergent clinical issue (e.g. clinical study, scientific report, draft regulation) is released that requires an immediate or rapid response, particularly if it is anticipated that it will generate a multitude of inquiries. A Practice Advisory is a brief, focused statement issued within 24-48 hours of the release of this evolving information and constitutes ACOG clinical guidance. A Practice Advisory is issued only on-line for Fellows but may also be used by patients and the media. Practice Advisories are reviewed periodically for reaffirmation, revision, withdrawal or incorporation into other ACOG guidelines.
This document reflects emerging clinical and scientific advances as of the date issued and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed.
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The American College of Obstetricians and Gynecologists (The College), a 501(c)(3) organization, is the nation’s leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of approximately 58,000 members, The College strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women’s health care. The American Congress of Obstetricians and Gynecologists (ACOG), a 501(c)(6) organization, is its companion organization. www.acog.org