SGO Position Statement: Pelvic Examinations
After a review of available clinical evidence, the US Preventive Services Task Force is releasing a statement about the use of pelvic exams in primary care, concluding that “the current evidence is insufficient to assess the balance of benefits and harms of performing screening pelvic examinations in asymptomatic, nonpregnant adult women.” The designated “grade” of ‘I’ (insufficient evidence) is neither a recommendation nor discouragement of the practice. However, the SGO is concerned that this statement will be easily misinterpreted as a recommendation against pelvic exams, with the result being a deficiency in care provided to women.
While it is true that there are no clinical data demonstrating a reduction in morbidity or mortality at a population level by performing an annual pelvic exam on asymptomatic women at the time of their well-woman exam, it is not true that pelvic exams lack value.
The SGO recommends that providers continue to offer pelvic exams to every patient presenting for a well-woman examination.
Offering a pelvic exam to every woman opens up an important dialogue between patient and provider, serving as an opportunity for patient education and advocacy regarding risk factors for and signs and symptoms of gynecologic malignancies and other disorders of the female reproductive system. Every woman deserves this discussion and opportunity to make an informed decision for herself of whether to undergo a pelvic exam.
Pelvic exams, while more invasive than cardiopulmonary exams, are the only tool a provider has to examine the female reproductive system. Screening pelvic exams should be offered to women even if “asymptomatic,” to ensure that optimal evaluation is provided for women who may not recognize that their symptoms are important or abnormal, or may be embarrassed to volunteer symptoms involving their reproductive health. The SGO emphasizes the importance of offering this examination as part of a comprehensive evaluation of the entire patient, without neglecting an entire organ system.
Pelvic exams done when women are asymptomatic are also valuable in establishing awareness of an individual woman’s pelvic anatomy as a baseline for future visits. Unlike a man’s ability to be aware of his own reproductive organs, or a woman’s ability to have self-breast awareness, making the crucial distinction between normal anatomic variations of female pelvic anatomy and actual pathology requires that an experienced examiner have knowledge of what findings are new or different from previous examinations.
The SGO values the model of shared decision-making between patient and provider, based on the individual woman’s risk factors, goals and philosophies. In the hands of a skilled and experienced provider, trained in proper techniques and awareness of the impact of psychosocial factors such as a history of trauma, a pelvic exam is not likely to cause harm. Therefore, SGO continues to recommend a pelvic exam be offered annually to every woman getting preventative health care, in the context of a balanced discussion of the risks and benefits, so that each woman may participate in the decision to have her reproductive system evaluated.