Clinician Article
Screening for Gynecologic Conditions With Pelvic Examination: US Preventive Services Task Force Recommendation Statement.
PMID: 28267862
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Family Medicine (FM)/General Practice (GP)Relevance - 6/7
Newsworthiness - 5/7 -
General Internal Medicine-Primary Care(US)Relevance - 6/7
Newsworthiness - 5/7 -
Public HealthRelevance - 6/7
Newsworthiness - 5/7 -
GynecologyRelevance - 4/7
Newsworthiness - 3/7
Abstract
IMPORTANCE: Many conditions that can affect women's health are often evaluated through pelvic examination. Although the pelvic examination is a common part of the physical examination, it is unclear whether performing screening pelvic examinations in asymptomatic women has a significant effect on disease morbidity and mortality.
OBJECTIVE: To issue a new US Preventive Services Task Force (USPSTF) recommendation on screening for gynecologic conditions with pelvic examination for conditions other than cervical cancer, gonorrhea, and chlamydia, for which the USPSTF has already made specific recommendations.
EVIDENCE REVIEW: The USPSTF reviewed the evidence on the accuracy, benefits, and potential harms of performing screening pelvic examinations in asymptomatic, nonpregnant adult women 18 years and older who are not at increased risk for any specific gynecologic condition.
FINDINGS: Overall, the USPSTF found inadequate evidence on screening pelvic examinations for the early detection and treatment of a range of gynecologic conditions in asymptomatic, nonpregnant adult women.
CONCLUSIONS AND RECOMMENDATION: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of performing screening pelvic examinations in asymptomatic, nonpregnant adult women. (I statement) This statement does not apply to specific disorders for which the USPSTF already recommends screening (ie, screening for cervical cancer with a Papanicolaou smear, screening for gonorrhea and chlamydia).
Clinical Comments
General Internal Medicine-Primary Care(US)
I have never understood why women without disease process or symptoms are told to come in for a "pelvic" exam. If they have none of the mentioned symptoms/disease processes, it is likely a waste of time ($$). I would think the decision should be patient specific based on your knowledge of the individual.
General Internal Medicine-Primary Care(US)
As a primary care doctor, I knew that my care of women was rational - I do not do a screening pelvic examination. It is good to be blessed by the USPSTF.
General Internal Medicine-Primary Care(US)
Very nice editorial that summarizes the issues at hand and emphasizes shared decision-making.
Public Health
Routine pelvic exam in asymptomatic women is very uncommon in the U.K. It is more frequent in Europe where it usually includes an ultrasound scan of the pelvis.
Public Health
The recommendations by USPSTF finally spells out what has long been known/held by most physicians but were (somewhat) compelled to practice in real life - pelvic examination in healthy/asymptomatic females. These recommendations would lend (evidence based) credence to the school of thought of limiting the invasive procedures/interventions as a screening tool in otherwise low risk/asymptomatic population and thereby allay anxieties and fears.
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