Screening Pelvic Examinations in Asymptomatic, Average-Risk Adult Women

Abstract

Pelvic examinations are commonly performed as part of the routine care visit in asymptomatic, nonpregnant, adult women to screen for cancer, infections, asymptomatic pelvic inflammatory disease, and other pathological conditions. Many clinicians and women believe that pelvic examination should be part of the annual well-women visits. However, routine pelvic examination is low-value care and has questionable benefit, and many clinicians believe that it should not be performed. This study presents available evidence on the diagnostic accuracy, benefits, and harms of routine screening for pathology during routine screening pelvic examinations in adult, asymptomatic, average-risk, nonpregnant women. These findings were the basis for the American College of Physicians (ACP) clinical practice guideline (Qaseem et al, Ann Intern Med 2014;161:67-72). Data were obtained by a systematic review of the published literature in the English language from 1946 through January 2014 using MEDLINE and hand searching. Assessed outcomes were evidence of benefits (decreased morbidity and mortality) and harms. No evidence was found that routine screening pelvic examination in asymptomatic, nonpregnant, adult women has any benefit, and there was indirect evidence that it does not reduce morbidity or mortality rates. Potential harms include overdiagnosis (false-positive findings), overtreatment (unnecessary laparoscopies or laparotomies), and diagnostic procedure-related harms. Patient-related harms (based on low-quality evidence) include fear, anxiety, embarrassment, pain or discomfort, and avoidance of necessary care. The annual cost of performing routine pelvic examination in the United States is substantial (?$2.6 billion). These findings show that routine screening pelvic examination is potentially harmful and does not reduce mortality or morbidity rates in asymptomatic adult women. Moreover, it adds unnecessary cost to the health care system in the United States. Based on these data, the ACP guideline recommended against use of screening pelvic examination in asymptomatic, nonpregnant, adult women.