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ACP's new evidence-based guideline finds that harms of
screening pelvic examination outweigh any demonstrated
PHILADELPHIA, July 1, 2014 -- Many women and physicians believe
that a pelvic examination should be part of annual well visits, but
an analysis of the current evidence by the American College of
Physicians (ACP) shows that the harms outweigh any demonstrated
ACP's new evidence-based clinical practice guideline, "Screening
Pelvic Examination in Adult Women," was published today in
Annals of Internal Medicine, ACP's flagship journal. ACP's
guideline is based on a systematic review of the published
literature on human subjects in the English language from 1946
through January 2014.
"Routine pelvic examination has not been shown to benefit
asymptomatic, average risk, non-pregnant women. It 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 Dr. Linda Humphrey, a co-author
of the guideline and a member of ACP's Clinical Practice Guidelines
Committee. Dr. Humphrey notes that this guideline does not apply to
Pap smear screening, only the pelvic examination.
ACP states that when screening for cervical cancer, the
recommended examination should be limited to visual inspection of
the cervix and cervical swabs for cancer and for some women human
papillomavirus (HPV), and does not need to include the bimanual
examination. ACP found that the diagnostic accuracy of the pelvic
examination for detecting gynecologic cancer or infections is low.
ACP advises that the pelvic examination is appropriate for women
with symptoms such as vaginal discharge, abnormal bleeding, pain,
urinary problems, or sexual dysfunction.
ACP's guideline includes High Value Care advice to help
doctors and patients understand the benefits, harms, and costs of
the pelvic examination so they can pursue care together that
improves health, avoids harms, and eliminates wasteful
"Screening pelvic examination exposes adult, asymptomatic,
average risk, non-pregnant women to unnecessary and avoidable
harms, including anxiety, embarrassment, and discomfort, and may
even prevent some women from getting needed medical care," said Dr.
Molly Cooke, ACP's Immediate Past President and a member of ACP's
Clinical Practice Guidelines Committee. "False positive findings
can lead to unnecessary tests or procedures, adding additional
unnecessary costs to the health care system."
In an editorial
also published in the July 1 issue of Annals of Internal
Medicine, Dr. George Sawaya and Dr. Vanessa Jacoby of the
Department of Obstetrics, Gynecology and Reproductive Sciences at
the University of California, San Francisco write, "The pelvic
examination has held a prominent place in women's health for many
decades and has come to be more of a ritual than an evidence-based
practice...With the current state of evidence, clinicians who
continue to offer the examination should at least be cognizant
about the uncertainty of its benefits and its potential to cause
harm through false-positive testing and the cascade of events it
About the American College of PhysiciansThe American College of Physicians is the largest
medical specialty organization and the second-largest physician
group in the United States. ACP members include 137,000 internal
medicine physicians (internists), related subspecialists, and
medical students. Internal medicine physicians are specialists who
apply scientific knowledge and clinical expertise to the diagnosis,
treatment, and compassionate care of adults across the spectrum
from health to complex illness. Follow ACP on Twitter and Facebook.