Most women are accustomed to the uncomfortable ritual of having a yearly pelvic examination. But a new guideline from the American College of Physicians (ACP) suggests it may be time to make the procedure a thing of the past for women without any symptoms of concern. The recommendation does not apply to pregnant women or those who have signs of illness.
Women should continue to receive routine cervical cancer screening, according to the ACP, but the procedure should include only visual inspection and swabbing of the cervix, not a physical evaluation of the uterus. The ACP cautioned, however, that a pelvic examination is advisable for women who have vaginal discharge, abnormal bleeding, pain, urinary difficulties, or sexual dysfunction.
The recommendation is likely to be extremely controversial. The American College of Obstetricians and Gynecologists continues to recommend routine pelvic examinations as part of an annual well-woman visit. However, the ACP argues that there is no clear evidence of benefit, so the harms of fear, anxiety, embarrassment, pain, discomfort, and false positives outweigh the potential benefit of routinely conducting pelvic examinations on apparently healthy women.
The recommendation is based on the ACP’s review of the evidence on pelvic examinations from 1946 through 2014. The review found that pelvic examinations on apparently healthy women rarely detect noncervical cancer or other treatable conditions and that the practice didn’t improve patient outcomes.
“[Routine pelvic examination] rarely detects important disease and does not reduce mortality and is associated with discomfort for many women, false-positive and -negative examinations, and extra cost,” said Linda Humphrey, MD, a coauthor of the guideline.
An accompanying editorial noted that it’s not clear whether the ACP’s recommendation will change the practice of obstetrician/gynecologists. The editorialists note that the evidence base is limited and many gynecologists believe pelvic examinations help detect noncancerous masses, but they argue that clinicians should be aware of both the potential harms of pelvic examinations and the uncertainty surrounding benefits of the procedure.