On June 28, 2016, the U.S. Preventive Services Task Force (USPSTF) released a draft recommendation statement, "Gynecological Conditions: Periodic Screening With the Pelvic Examination." The USPSTF lists the draft recommendation as an "I" statement, which means that it concluded that there is not enough evidence to determine the benefits or harms of performing screening pelvic exams (external inspection, internal speculum examination, bimanual examination, and rectovaginal examination) in asymptomatic, non-pregnant adult women.
It is important to understand that the USPSTF draft "I" statement applies only to a screening pelvic examination for four specific conditions: ovarian cancer; bacterial vaginosis; genital herpes; and trichomoniasis. No studies were identified to address other conditions. This USPSTF draft recommendation only applies to non-pregnant, asymptomatic women.
The American College of Obstetricians and Gynecologists (the College) is reviewing the USPSTF draft 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 USPSTF Draft Recommendation Means
More research is needed, as indicated by the USPSTF's draft "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, not only for the four specific conditions the USPSTF draft recommendation addresses, but for other reasons a screening pelvic examination might be performed.
Women should see an obstetrician-gynecologist at least once a year for well-woman care (see 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.
There are some women who may benefit from a screening pelvic examination depending on their individual health condition and information shared during the encounter.
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 annual 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.
What The USPSTF Draft Recommendation Does NOT Mean
This "I" statement from the USPSTF should NOT be interpreted to mean that a 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. The USPSTF concluded that evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined. This is NOT a recommendation that there is no net benefit or that the harms outweigh the benefits (a "D"-grade).
The USPSTF draft 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 draft recommendation applies only to asymptomatic, non-pregnant women.
This does NOT affect the USPSTF's recommendations for cervical cancer, gonorrhea, and chlamydial screenings.
This should NOT affect coverage under the Patient Protection and Affordable Care Act (the ACA). The Institute of Medicine’s 2011 recommendation for at least one well-woman preventive care visit annually for adult women to obtain the recommended preventive services, including preconception and prenatal care, is fully covered without requiring a patient cost-sharing under the ACA.
How to Provide Feedback to the USPSTF
The USPSTF draft recommendation is NOT final. ACOG Fellows may submit comments directly to the USPSTF until July 25, 2016. Public comments will be considered and a final recommendation statement will be released in upcoming months.
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 online 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