The Pelvic Examination as a Screening Tool | Gynecology | JAMA Internal Medicine | JAMA Network
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Centers for Disease Control and Prevention.  National Ambulatory Medical Care Survey: 2008 summary tables. Accessed March 2, 2011
ACOG Committee on Practice Bulletins—Gynecology.  ACOG Practice Bulletin No. 109: cervical cytology screening.  Obstet Gynecol. 2009;114(6):1409-142020134296PubMedGoogle Scholar
Westhoff CL, Jones HE, Guiahi M. Do new guidelines and technology make the routine pelvic examination obsolete?  J Womens Health (Larchmt). 2011;20(1):5-1021194307PubMedGoogle ScholarCrossref
Smith RA, Cokkinides V, Brawley OW. Cancer screening in the United States, 2009: a review of current American Cancer Society guidelines and issues in cancer screening.  CA Cancer J Clin. 2009;59(1):27-4119147867PubMedGoogle ScholarCrossref
Stewart FH, Harper CC, Ellertson CE, Grimes DA, Sawaya GF, Trussell J. Clinical breast and pelvic examination requirements for hormonal contraception: current practice vs evidence.  JAMA. 2001;285(17):2232-223911325325PubMedGoogle ScholarCrossref
Centers for Disease Control and Prevention (CDC).  CDC Grand Rounds: chlamydia prevention: challenges and strategies for reducing disease burden and sequelae.  MMWR Morb Mortal Wkly Rep. 2011;60(12):370-37321451447PubMedGoogle Scholar
Stewart RA, Thistlethwaite J, Evans R. Pelvic examination of asymptomatic women—attitudes and clinical practice.  Aust Fam Physician. 2008;37(6):493-49618523709PubMedGoogle Scholar
US Preventive Services Task Force.  Screening for ovarian cancer: recommendation statement.  Ann Fam Med. 2004;2(3):260-26215209204PubMedGoogle ScholarCrossref
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    1 Comment for this article
    A narrow view of a problem can lead to narrow conclusions
    Luis Velez, MD, PhD | UT MD Anderson Cancer Center
    I am concerned that this research letter is to some degree misleading. First, the analysis of pelvic exams is too narrow. Pelvic exams are not good practice for the detection of ovarian cancer. But the fact that many doctors still believe it is does not negate in any way the utility of pelvic exams for the detection of other reproductive tract problems. If many doctors do it for the wrong reason, what is wrong is the 'reason', not the usefulness of the exam as part of a well-woman visit.
    Secondly, the article does not take into consideration the fact
    that minority, uninsured, poor, overweight, and disabled women often see their doctor only when they feel really sick. Avoiding a pelvic exam in these patients is no doubt a missed opportunity to detect important problems; perhaps not an ovarian cancer, but surely other diseases.
    It might be considered old school when doctors were supposed to thoroughly examine their patients. But too much research is done on how to use diagnostic aids and not on how to use medical semiology to guide diagnostic suspicion and to re-humanize medicine. By further eliminating detailed use of their senses in the evaluation of patients, doctors risk soon being totally replaced by automated mechanisms that can process more efficiently the overwhelming amount of lab information that now guides medical practice, while at the same time continue raising health care costs beyond the already absurd levels of today.

    Conflict of Interest: None declared
    Research Letter
    Dec 12 2011

    The Pelvic Examination as a Screening Tool

    Author Affiliations

    Author Affiliations: Division of Cancer Prevention and Control, CDC, Atlanta, Georgia (Ms Stormo and Drs Hawkins and Saraiya); and Soltera Center for Cancer Prevention and Control Research, Tucson, Arizona (Dr Cooper).

    Arch Intern Med. 2011;171(22):2053-2054. doi:10.1001/archinternmed.2011.575

    According to the Centers for Disease Control and Prevention (CDC), approximately 63.4 million pelvic examinations were performed in US physicians' offices and US clinics in 2008.1 Traditionally, this procedure has been performed in conjunction with annual Papanicolaou tests but since the American College of Obstetricians and Gynecologists extended its recommended cervical cancer screening interval to no more than every 3 years with human papillomavirus co-testing,2 there are questions about whether an annual pelvic examination is needed.

    Pelvic examinations have been performed on asymptomatic women to screen for sexually transmitted infections, to screen for ovarian and other gynecologic cancers, and to determine whether women should receive hormonal contraceptives. However, use of pelvic examinations for these purposes is not supported by scientific evidence and is not recommended by any US organization.3-6