ACP Provides Guidance on Screening Pelvic Examination in Women.

Pelvic examinations, consisting of speculum and bimanual examination for the purpose of this guideline, are often performed in women without symptoms to screen for pathology, including cancer, infection, and pelvic inflammatory disease (PID). However, their accuracy for diagnosing PID, gynecologic cancer (not including cervical or ovarian cancer), and benign conditions has not been addressed in studies, and their accuracy for diagnosing ovarian cancer and bacterial vaginosis is low. Additionally, pelvic examination is associated with many false-positive findings and harms from examination (e.g., unneeded laparoscopies or laparotomies, fear, anxiety). Routinely performing pelvic examinations increases health care costs, with total yearly cost of preventive examinations, and the related laboratory tests and radiology, in the United States estimated at more than $2.5 billion. This guideline from the American College of Physicians (ACP) provides evidence on the use of pelvic examination to screen for pathology in average-risk, nonpregnant women. This guideline concentrates on screening in women without symptoms; a pelvic examination with bimanual examination may be used in some nonscreening circumstances. Additionally, the group due for cervical cancer screening is not addressed in this guideline, but screening should be done by visual inspection of the cervix and cervical swabs, rather than performing a full pelvic examination.