USPSTF: Insufficient evidence for periodic pelvic examinations

There is a lack of current evidence to determine the balance of benefits and harms of performing periodic screening pelvic examinations in asymptomatic, nonpregnant adult women, according to a recommendation statement by the U.S. Preventive Services Task Force.

“Many conditions that can affect women’s health are often evaluated through pelvic examination,” Kirsten Bibbins-Domingo, PhD, MD, MAS, wrote on behalf of the USPSTF.

Kirsten Bibbins-Domingo

“Pelvic examination is a common part of the physical examination; in 2012, an estimated 44.2 million pelvic examinations were performed in the United States,” she added. “... It is unclear whether performing screening pelvic examinations in asymptomatic women reduces morbidity and mortality.”

The I-grade statement, published in JAMA, was based on a systematic review of nine studies including 27,630 individuals. The task force reviewed the evidence on the accuracy, health benefits and potential harms of screening for gynecologic conditions, including ovarian cancer, bacterial vaginosis, genital herpes and trichomoniasis, through pelvic examinations.

Overall, the USPSTF found inadequate evidence on the benefits and harms of performing screening pelvic examinations for the early detection and treatment of a variety of gynecologic conditions in asymptomatic, nonpregnant women who are not at an elevated risk for any specific gynecologic condition. The reviewers found no trials that assessed the efficacy of the pelvic examination in reducing all-cause mortality, reducing cancer- and disease-specific morbidity and mortality or improving quality of life.

The USPSTF noted that it already recommends screening for cervical cancer, gonorrhea and chlamydia and therefore, this recommendation statement does not apply to those disorders.

In an accompanying editorial, Colleen McNicholas, DO, MSCI, of the department of obstetrics and gynecology at Washington University School of Medicine, and Jeffrey F. Peipert, MD, PhD, of the department of obstetrics and gynecology at Indiana University School of Medicine, wrote that the USPSTF recommendation is not surprising, noting that while medical students are taught to perform a careful and thorough history and physical examination, there is no evidence to support such practice.

“Even though the USPSTF determined that the available evidence was insufficient to support or refute the annual pelvic examination in asymptomatic, nonpregnant women, it is not clear that the pelvic examination should be abandoned,” they concluded. “Women, as patients, should be involved in the decision regarding whether to perform a pelvic examination, and clinicians should not require that the patient undergo this procedure to obtain screening, counseling, and age-appropriate health services.” – by Alaina Tedesco

References:

USPSTF. JAMA. 2017;doi:10.1001/jama.2017.0807.

Guirguis-Blake JM. JAMA. 2017;doi:10.1001/jama.2016.12819.

McNicholas C, Peipert JF. JAMA. 2017;doi:10.1001/jama.2017.0899.

Disclosures: USPSTF is supported by the Agency for Healthcare Research and Quality. Peipert reported receiving grants from Teva Pharmaceuticals, Bayer Healthcare Pharmaceuticals, and Merck and serving on the advisory boards of Perrigo and Teva. McNicholas reported no relevant financial disclosures.