Annual pelvic exam

The American College of Physicians (ACP) clinical guidelines recommends against performing the screening pelvic examination in asymptomatic, non-pregnant women.

The screening pelvic exam historically has included the speculum and bimanual examination to palpate the uterus, ovaries, and adnexa, and occasionally the rectum.

Qaseem and colleagues performed a systematic review evaluating outcomes on the diagnostic accuracy of the annual pelvic examination for conditions such as ovarian cancer and bacterial vaginosis and the potential harm and benefits of performing a screening pelvic examination: no evidence for the reduction of ovarian cancer morbidity or mortality in patients screened with a bimanual pelvic examination was found.

The diagnosis of bacterial vaginosis can be obtained through meeting 3 out of 4 of the Amsel criteria, none of which requires a speculum or bimanual examination.

Harms of the screening pelvic examination include: pelvic discomfort, pain, fear, anxiety, embarrassment, unnecessary testing and procedures due to false-positives and over-diagnosis on the examination.

Women may also avoid seeking medical care due to the above problems.

The ACP recommends that well-woman examinations not include a pelvic examination and that the cervical cancer screening should exclude the bimanual examination and be limited to the visual inspection of the cervix and the cervical swabs for cytology and human papilloma virus.

The well-woman examination still serves multiple purposes, including prevention and lifestyle counseling, immunizations, identifying other medical problems and performing the clinical breast examination.

Bimanual pelvic examination screening test in asymptomatic women should not be performed as it has no effect on morbidity or mortality from cancers or benign gynecological conditions.

The American College of Obstetricians and Gynecologists (ACOG) in its 2012 policy statement does recommend annual screening pelvic examinations in asymptomatic patients as part of its well-woman examination, but there is no evidence to support this recommendation.

The positive predictive value of the procedure is significantly low and not cost-effective.

Indications for a screening or non-screening bimanual examination in other patients include: the high-risk patient, abnormal bleeding, pelvic pain, vaginal discharge, urinary dysfunction, or sexual dysfunction.

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