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Ann Intern Med. 2014 Jul 1;161(1):46-53. doi: 10.7326/M13-2881.

Screening pelvic examinations in asymptomatic, average-risk adult women: an evidence report for a clinical practice guideline from the American College of Physicians.

Abstract

BACKGROUND:

Pelvic examination is often included in well-woman visits even when cervical cancer screening is not required.

PURPOSE:

To evaluate the diagnostic accuracy, benefits, and harms of pelvic examination in asymptomatic, nonpregnant, average-risk adult women. Cervical cancer screening was not included.

DATA SOURCES:

MEDLINE and Cochrane databases through January 2014 and reference lists from identified studies.

STUDY SELECTION:

52 English-language studies, 32 of which included primary data.

DATA EXTRACTION:

Data were extracted on study and sample characteristics, interventions, and outcomes. Quality of the diagnostic accuracy studies was evaluated using a published instrument, and quality of the survey studies was evaluated with metrics assessing population representativeness, instrument development, and response rates.

DATA SYNTHESIS:

The positive predictive value of pelvic examination for detecting ovarian cancer was less than 4% in the 2 studies that reported this metric. No studies that investigated the morbidity or mortality benefits of screening pelvic examination for any condition were identified. The percentage of women reporting pelvic examination-related pain or discomfort ranged from 11% to 60% (median, 35%; 8 studies [n = 4576]). Corresponding figures for fear, embarrassment, or anxiety ranged from 10% to 80% (median, 34%; 7 studies [n = 10 702]).

LIMITATION:

Only English-language publications were included; the evidence on diagnostic accuracy, morbidity, and mortality was scant; and the studies reporting harms were generally low quality.

CONCLUSION:

No data supporting the use of pelvic examination in asymptomatic, average-risk women were found. Low-quality data suggest that pelvic examinations may cause pain, discomfort, fear, anxiety, or embarrassment in about 30% of women.

PRIMARY FUNDING SOURCE:

Department of Veterans Affairs.

PMID:
24979449
DOI:
10.7326/M13-2881
[Indexed for MEDLINE]

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