Screening for Gynecologic Conditions With Pelvic Examination

Abstract

he US Preventive Services Task Force (USPSTF) makes recommendations about the effectiveness of specific preventive care services for patients without obvious related signs or symptoms.It bases its recommendations on the evidence of both the benefits and harms of the service and an assessment of the balance. The USPSTF does not consider the costs of providing a service in this assessment.The USPSTF recognizes that clinical decisions involve more considerations than evidence alone. Clinicians should understand the evidence but individualize decision making to the specific patient or situation. Similarly, the USPSTF notes that policy and coverage decisions involve considerations in addition to the evidence of clinical benefits and harms. Summary of Recommendation and EvidenceThe USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of performing screening pelvic examinations in asymptomatic, nonpregnant adult women (I statement) (Figure 1).This statement does not apply to specific disorders for which the USPSTF already recommends screening (ie, screening for cervical cancer with a Papanicolaou ["Pap"] smear, screening for gonorrhea and chlamydia). See the eTable in the Supplement. RationaleImportance Many conditions that can affect women's health are often evaluated through pelvic examination. These conditions include but are not limited to malignant diseases, such as ovarian, uterine, vaginal, and cervical cancer; infectious diseases, such as bacterial vaginosis, candidiasis, genital warts, genital herpes, trichomoniasis, and pelvic inflammatory disease; and other benign conditions, such as cervical polyps, endometriosis, ovarian cysts, dysfunction of the pelvic wall and floor, and uterine fibroids. Pelvic examination is a common part of the physical examination; in 2012, an IMPORTANCE Many conditions that can affect women's health are often evaluated through pelvic examination. Although the pelvic examination is a common part of the physical examination, it is unclear whether performing screening pelvic examinations in asymptomatic women has a significant effect on disease morbidity and mortality.OBJECTIVE ToissueanewUSPreventiveServicesTaskForce(USPSTF)recommendationonscreening forgynecologicconditionswithpelvicexaminationforconditionsotherthancervicalcancer,gonorrhea, and chlamydia, for which the USPSTF has already made specific recommendations. EVIDENCE REVIEWThe USPSTF reviewed the evidence on the accuracy, benefits, and potential harms of performing screening pelvic examinations in asymptomatic, nonpregnant adult women 18 years and older who are not at increased risk for any specific gynecologic condition.FINDINGS Overall, the USPSTF found inadequate evidence on screening pelvic examinations for the early detection and treatment of a range of gynecologic conditions in asymptomatic, nonpregnant adult women. CONCLUSIONS AND RECOMMENDATIONThe USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of performing screen...

Exploring Iranian women’s perceptions and experiences regarding cervical cancer-preventive behaviors

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