The American College of Physicians (ACP) has issued new controversial clinical guidelines recommending against screening pelvic examinations in asymptomatic, nonpregnant, adult women. Just published in the Annals of Internal Medicine, the authors reviewed the evidence and decided that the harms associated with screening pelvic exams outweigh the benefits.
The new recommendations set off a lot of strong reactions among physicians and women’s health groups, including well-respected experts in the industry who are split on the recommendations.
The ACP guideline was established after a systematic review of the published literature in the English language from 1946 through January 2014 identified using MEDLINE and hand-searching. The outcomes under evaluation included morbidity, mortality, and harms (ie, overdiagnosis, overtreatment, diagnostic procedure–related harms, fear, anxiety, embarrassment, pain, and discomfort).
Researchers found that the yield of pelvic examination for identifying cancer or other treatable disease in nonpregnant women without symptoms was low and not associated with improved health outcomes. However, the ACP guidelines are not being met with widespread praise. A recent press release by the American College of Obstetricians and Gynecologists (ACOG) states that it stands by its current guidelines for well-women visits, which includes pelvic examinations.
“We continue to urge women to visit their health care providers for annual visits, which play a valuable role in patient care,” said John C. Jennings, MD, president of ACOG, in a news release. “An annual well-woman visit can help physicians to promote healthy living and preventive care, to evaluate patients for risk factors for medical conditions, and to identify existing medical conditions, thereby opening the door for treatment. Annual well-woman visits are important for quality care of women and their continued health.”
These new recommendations open the doors to continued debate over physical exams and questions when they are appropriate.
Download the full guideline, Screening Pelvic Examination in Adult Women: A Clinical Practice Guideline from the American College of Physicians (PDF).