Examining the evidence for women's annual examinations

Background:  The pelvic exam has been considered an integral part of the women’s health annual wellness visit in modern times.  How it actually contributes to the identification of problems, and how it supports women’s continued health, is currently under consideration by some researchers.

Purpose:  Current recommendations for preventive women’s health care by the United States Preventive Services Task Force and the Institute of Medicine challenge many traditional practices, and this presentation will examine the evidence behind these practices, with a focus on the annual pelvic exam.

Methods:  Recent screening guidelines for women’s preventive health have provided the opportunity to re-examine the role of many components of women’s exams, including annual Pap smears and screening mammograms.  Because providing an evidence base for treatment modalities in health care has become the basis for providing cost-effective, outcomes-oriented care, examining the evidence for performing pelvic exams as part of preventive care is a logical step in identifying the value of this intrusive, and sometimes unpleasant, exam.  The history of pelvic exams and the information provided by an exam performed in the absence of specific symptoms or a patient complaint will be discussed.  The value of the pelvic exam for provision of diagnosis will be reviewed, with an emphasis on the importance placed on the identification of benign conditions.

Conclusion:  Following evidence-based practice is a key component of providing appropriate care.  The performance of the routine pelvic exam has been adopted as a standard of care, with little evidence to support its value for diagnosis and treatment.