Pelvic exam

Medical guidelines

Traditionally in the field of gynecology, the benefits of routine pelvic examinations were assumed, and the exam was a recommended part of the initial gynecology visit, annual visits, and as needed for treatment. In 2014, the American College of Physicians (ACP) published a review of the benefits and the risks of the exam and issued a guideline that recommended against performing this examination to screen for conditions in asymptomatic, nonpregnant, adult women, concluding that the potential harms outweighed the demonstrated benefits and that screening pelvic exams in asymptomatic women did not reduce mortality or morbidity rates. The guideline did not consider the necessity or frequency of Pap smears. The ACP guideline concluded that there was no evidence that the exam in asymptomatic adult women reduced morbidity or mortality, and that there were no studies that addressed the exam's diagnostic accuracy for identifying specific gynecologic conditions. The guideline concluded that there was evidence of harm, including fear, embarrassment, pain, discomfort and unnecessary surgery. This was a strong recommendation, based on moderate-quality evidence. In 2018, the American College of Obstetricians and Gynecologists (ACOG) issued a committee opinion that pelvic exams should be performed for 1) symptoms of gynecologic disease, 2) screening for cervical dysplasia, or 3) management of gynecologic disorders or malignancy, using shared decision-making with the patient. ACOG acknowledged that given changes in screening recommendations and an assessment of harms vs benefits as reviewed by the US Preventive Services Task Force, re-evaluation of routine screening pelvic examination for asymptomatic, non-pregnant women with average risk for gynecologic disease was indicated. A 2020 update of the literature by the US Preventive Services Task Force concluded that the evidence remained insufficient to assess the balance of benefits and harms of screening pelvic examinations in asymptomatic women.