Screening Pelvic Examinations: Right, Wrong, or Rite?
Authors: George F. Sawaya, Vanessa Jacoby
Journal: Annals of Internal Medicine (2014)

Editorials1 July 2014Screening Pelvic Examinations: Right, Wrong, or Rite?George F. Sawaya, MD and Vanessa Jacoby, MD, MASGeorge F. Sawaya, MDFrom University of California, San Francisco, San Francisco, California.Search for more papers by this author and Vanessa Jacoby, MD, MASFrom University of California, San Francisco, San Francisco, California.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M14-1205 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In the modern era, many routine practices are being reevaluated through a lens of not only evidence, but also value. In this issue, the American College of Physicians discusses the screening pelvic examination and gives a “strong” recommendation against it being done in asymptomatic, nonpregnant adult women (1). The recommendation is based on a systematic review (2) that found “no data in support of the examination” but did find evidence of harms ranging from distress to unnecessary surgery.This recommendation will be controversial. Pelvic examination has long been considered a fundamental component of the well-woman visit, and 62.8 million were ...References1. Qaseem A, Humphrey LL, Harris R, Starkey M, Denberg TD; Clinical Guidelines Committee of the American College of Physicians. Screening pelvic examination in adult women: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2014;161:67-72. LinkGoogle Scholar2. Bloomfield HE, Olson A, Greer N, Cantor A, MacDonald R, Rutks I, et al. Screening pelvic examinations in asymptomatic, average-risk adult women: an evidence report for a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2014;161:46-53. LinkGoogle Scholar3. Ambulatory and Hospital Care Statistics Branch. National Ambulatory Medical Care Survey: 2010 Summary Tables. Atlanta, GA: Centers for Disease Control and Prevention; 2010. Accessed at www.cdc.gov/nchs/data/ahcd/namcs_summary/2010_namcs_web_tables.pdf on 18 May 2014. Google Scholar4. Committee on Gynecologic Practice. Committee opinion no. 534: well-woman visit. Obstet Gynecol. 2012;120:421-4. [PMID: 22825111] CrossrefMedlineGoogle Scholar5. Henderson JT, Harper CC, Gutin S, Saraiya M, Chapman J, Sawaya GF. Routine bimanual pelvic examinations: practices and beliefs of US obstetrician-gynecologists. Am J Obstet Gynecol. 2013;208:109.e1-7. [PMID: 23159688] CrossrefMedlineGoogle Scholar6. Henderson JT, Yu JM, Harper CC, Sawaya GF. U.S. clinicians' perspectives on less frequent routine gynecologic examinations. Prev Med. 2014;62:49-53. [PMID: 24518004] CrossrefMedlineGoogle Scholar7. Sawaya GF, Guirguis-Blake J, LeFevre M, Harris R, Petitti D; U.S. Preventive Services Task Force. Update on the methods of the U.S. Preventive Services Task Force: estimating certainty and magnitude of net benefit. Ann Intern Med. 2007;147:871-5. [PMID: 18087058] LinkGoogle Scholar8. Stormo AR, Cooper CP, Hawkins NA, Saraiya M. Physician characteristics and beliefs associated with use of pelvic examinations in asymptomatic women. Prev Med. 2012;54:415-21. [PMID: 22484240] CrossrefMedlineGoogle Scholar9. Moyer VA; U.S. Preventive Services Task Force. Screening for ovarian cancer: U.S. Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med. 2012;157:900-4. [PMID: 22964825] LinkGoogle Scholar10. American College of Obstetricians anf Gynecologists. ACOG Committee Opinion: number 280, December 2002. The role of the generalist obstetrician-gynecologist in the early detection of ovarian cancer. Obstet Gynecol. 2002;100:1413-6. [PMID: 12468197] MedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From University of California, San Francisco, San Francisco, California.Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-1205.Corresponding Author: George F. Sawaya, MD, Department of Obstetrics, Gynecology and Reproductive Science, University of California, San Francisco, San Francisco, CA 94143.Current Author Addresses: Drs. Sawaya and Jacoby: Department of Obstetrics, Gynecology and Reproductive Science, University of California, San Francisco, San Francisco, CA 94143. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoScreening Pelvic Examinations in Asymptomatic, Average-Risk Adult Women: An Evidence Report for a Clinical Practice Guideline From the American College of Physicians Hanna E. Bloomfield , Andrew Olson , Nancy Greer , Amy Cantor , Roderick MacDonald , Indulis Rutks , and Timothy J. Wilt Screening Pelvic Examination in Adult Women: A Clinical Practice Guideline From the American College of Physicians Amir Qaseem , Linda L. Humphrey , Russell Harris , Melissa Starkey , Thomas D. Denberg , and Screening Pelvic Examination in Adult Women: A Clinical Practice Guideline From the American College of Physicians Amir Qaseem , Linda L. Humphrey , Russell Harris , Melissa Starkey , Thomas D. Denberg , and Screening Pelvic Examinations in Asymptomatic, Average-Risk Adult Women: An Evidence Report for a Clinical Practice Guideline From the American College of Physicians Hanna E. Bloomfield , Andrew Olson , Nancy Greer , Amy Cantor , Roderick MacDonald , Indulis Rutks , and Timothy J. Wilt Metrics Cited byThe midlife transition and the risk of cardiovascular disease and cancer Part II: strategies to maximize quality of life and limit dysfunction and diseasePrevalence of Potentially Unnecessary Bimanual Pelvic Examinations and Papanicolaou Tests Among Adolescent Girls and Young Women Aged 15-20 Years in the United StatesEffect of professional society recommendations on women’s desire for a routine pelvic examinationPatients and Their Bodies: The Physical ExamScreening Pelvic Examinations in Asymptomatic, Average-Risk Adult WomenHanna E. Bloomfield, MD, MPH, Andrew Olson, MD, and Timothy J. Wilt, MD, MPH 1 July 2014Volume 161, Issue 1Page: 78-79KeywordsHealth surveysLesionsMotivationObstetrics and gynecologyOvarian cancerOvarian cancer screeningOvariesSurgerySystematic reviewsUterus ePublished: 1 July 2014 Issue Published: 1 July 2014 Copyright & PermissionsCopyright © 2014 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...