ACP Recommends Against Screening Pelvic Exam

In the July 1, 2014 issue of Annals of Internal Medicine, a new American College of Physicians guideline was published, recommending against screening pelvic examination in adult, nonpregnant women without symptoms. It is important to note that this does not apply to Pap smear screening, which should continue ever 3 years in women who have not had a previous abnormal Pap smear, at least until age 65 in women who have not undergone hysterectomy. It is also important to note that this applies only to screening manual pelvic examinations, meaning that someone with symptoms or signs of a pelvic abnormality should still undergo this examination.

The guideline was based on a systematic review of all related evidence published in English between 1946 and January 2014, a total of 52 studies. The review concluded that these studies failed to provide any data to support the routine use of screening pelvic examination (excluding cervical cytologic examination, i.e., Pap smear) for reducing morbidity or mortality from any condition. Additionally, limited evidence suggests that screening pelvic examinations may be associated with pain, discomfort, fear, anxiety, or embarrassment in about one third of women and can lead to unnecessary, invasive, and potentially harmful diagnostic procedures. (1)

The bottom line is women should continue undergoing Pap smears as recommended by their physicians, but the recent recommendation is for physicians to not perform the bimanual portion of the examination unless warranted by symptoms or signs. Although this recommendation pertains to large scale screening, women should consult with their personal physician to determine what is best for them on an individual basis.

(1) Annals of Internal Medicine, Vol. 161, Number 1. July 1, 2014

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