Should the Annual Pelvic Examination Go the Way of Annual Cervical Cytology?

Abstract

sey theThe value of pelvic examination for healthy asymptomatic women has been called into question given the lack of benefit for ovarian and endometrial cancer screening, the ability to screen for sexually transmitted infections without a pelvic examination, and the uncoupling of the procurement of contraception with a pelvic examination. Still, there are indications for performing pelvic examinations in symptomatic women and in some high risk women. How do we as clinicians apply current evidence and expert opinion to our medical practice? Our recommendation to consider a pelvic examination at 3−5-year intervals with cervical cancer screening to elicit gynecologic and sexual health concerns offers a compromise between continuation of unnecessary annual pelvic examinations and complete elimination of these examinations. Keywords: bimanual • pelvic examination • screening • speculum examination BackgroundPelvic examination indications for healthy asymptomatic women have encompassed such preventive services as screening for cancer and infection. They have been associated with contraception counseling, evaluation and initiation. In previous years, pelvic examinations were performed annually for women in conjunction with cervical cancer screening, regardless of medical history or symptoms. In the past decade, cervical cancer screening guidelines have changed significantly favoring less frequent screening for most women. The most recent national guideline updates from the USA recommend cervical cytology every 3 years for women aged 21 years and older and include the option of 5-year cervical cytology/high-risk HPV co-testing for women 30-65 years old [1][2][3]. This has resulted in a major change in healthcare visit frequency. Women no longer need to schedule annual appointments for cervical cancer screening. Healthcare providers and researchers appropriately question the value of the annual pelvic examination for healthy asymptomatic women, its relationship to other gynecologic and preventive healthcare, and seek guidance regarding counseling patients. Herein, we will review traditional indications for pelvic examinations and review evidence and best practices from the USA and around the world. We will provide our perspective on answering the question: 'Should the annual pelvic examination go the way of annual cervical cytology?' What does a pelvic examination include?A comprehensive pelvic examination entails more than cervical cancer screening. It generally includes visualization of the external genitalia, a speculum examination of the vaginal and cervix, a bimanual examination of the uterus and adnexal areas, and a rectovaginal examination. The examination may include collection of cervical cytology (with or without HPV testing) for cervical cancer screening and endocervical or vaginal specimens to evaluate for infection. Pelvic examinations have commonly been performed for screening, symptom assessment and surveillance [4].Should the annual pelvic examination go the way of annual cervical cytology? Kathy Pelv...

Examining the Effects of Time to Diagnosis, Income, Symptoms, and Incidental Detection on Overall Survival in Epithelial Ovarian Cancer

“…17,18 Most of the current recommendations stem from 2 overlapping studies by Padilla et al 34,35 Both showed that pelvic examinations have limited efficacy; however, increasing experience improved detections rates. 35 Most guidelines recommend pelvic examinations for symptomatic women, 17,18 but none of the policies address the issue of experience and practice; in other words, if experience improves detection rates, then the only way to gain that technical skill is by doing multiple routine normal examinations. Finally, the PLCO (Prostate, Lung, Colorectal and Ovarian) Cancer Screening Trial included bimanual examination in both of its study groups until 1998, when it was abandoned in the screening arm alone.…”

Obstetrician–Gynecologist Practices and Beliefs Regarding External Genitalia Inspection and Speculum Examinations in Healthy Older Asymptomatic Women

“…It would be useful to have evidence to make recommendations based on whether external inspection and speculum examination can identify cancerous or benign lesions of significance and whether these examinations lead to better health outcomes or provide reassurance. Future research is also needed to evaluate the nondiagnostic benefits of these examinations, such as providing an opportunity to discuss questions or educate women about their anatomy, and why these benefits would not be expected from the visit itself apart from such examinations . Given that current guidelines are based on incomplete evidence and do not distinguish between different levels of health or account for comorbid conditions, it is important to discuss these limitations and elicit health goals from older women to provide more person‐centered gynecological care.…”