In 2012 the American College of Obstetricians and Gynecologists (ACOG) promoted annual screening pelvic examinations for non-pregnant women over the age of 21. This recommendation was reaffirmed in 2014.While acknowledging that the evidence for such exams is based more on clinical practice than on substantial experimental proof of efficacy, the ACOG noted The annual health assessment ( annual examination ) is a fundamental part of medical care and is valuable in promoting prevention practices, recognizing risk factors for disease, identifying medical problems, and establishing the clinician patient relationship.
On the other hand, the American College of Physicians (ACP) recently reviewed the efficacy of such screening exams, and recommended against them in a report published in the Annals of Internal Medicine. Dr. Amir Qaseem and colleagues from the ACP systematically reviewed the published literature from 1946 to 2014, looking for evidence of benefits or harms from such exams.
Although they found only moderate quality evidence, the ACP made a strong recommendation against such routine exams. They also took into account the costs to the health care system of exams that, they found, were not useful in detection of ovarian cancer or bacterial vaginosis (an infection caused when too much of certain bacteria change the normal balance of bacteria in the vagina).Further, they found low quality studies that indicated many women experienced anxiety, embarrassment, pain and discomfort associated with pelvic examinations. On the basis of their review, these authors concluded screening pelvic examination exposes women to unnecessary and avoidable harms with no benefit (reduced mortality or morbidity rates).
So, what is a woman to glean from these competing recommendations? wondered ACSH s Dr. Ruth Kava. Until further research supports one recommendation or the other, perhaps the wisest course is to consult with her own gynecologist and explore if and to what extent these advisories apply to her own situation, she continued.
