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, Timothy J. Wilt

Research output: Contribution to journalReview article

37 Scopus citations

Abstract

Background: Pelvic examination is often included in well-woman visits even when cervical cancer screening is not required. Purpose: To evaluate the diagnostic accuracy, benefits, and harms of pelvic examination in asymptomatic, nonpregnant, average-risk adult women. Cervical cancer screening was not included. Data Sources: MEDLINE and Cochrane databases through January 2014 and reference lists from identified studies. Study Selection: 52 English-language studies, 32 of which included primary data. Data Extraction: Data were extracted on study and sample characteristics, interventions, and outcomes. Quality of the diagnostic accuracy studies was evaluated using a published instrument, and quality of the survey studies was evaluated with metrics assessing population representativeness, instrument development, and response rates. Data Synthesis: The positive predictive value of pelvic examination for detecting ovarian cancer was less than 4% in the 2 studies that reported this metric. No studies that investigated the morbidity or mortality benefits of screening pelvic examination for any condition were identified. The percentage of women reporting pelvic examination-related pain or discomfort ranged from 11% to 60% (median, 35%; 8 studies [n = 4576]). Corresponding figures for fear, embarrassment, or anxiety ranged from 10% to 80% (median, 34%; 7 studies [n = 10 702]). Limitation: Only English-language publications were included; the evidence on diagnostic accuracy, morbidity, and mortality was scant; and the studies reporting harms were generally low quality. Conclusion: No data supporting the use of pelvic examination in asymptomatic, average-risk women were found. Low-quality data suggest that pelvic examinations may cause pain, discomfort, fear, anxiety, or embarrassment in about 30% of women.

Original languageEnglish (US)
Pages (from-to)46-53
Number of pages8
JournalAnnals of internal medicine
Volume161
Issue number1
DOIs
StatePublished - Jul 1 2014

ASJC Scopus subject areas

  • Internal Medicine

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