Screening pelvic examinations in asymptomatic, average-risk adult women: an evidence report for a clinical practice guideline from the American College of Physicians

Ann Intern Med. 2014 Jul 1;161(1):46-53. doi: 10.7326/M13-2881.


Background: Pelvic examination is often included in well-woman visits even when cervical cancer screening is not required.

Purpose: To evaluate the diagnostic accuracy, benefits, and harms of pelvic examination in asymptomatic, nonpregnant, average-risk adult women. Cervical cancer screening was not included.

Data sources: MEDLINE and Cochrane databases through January 2014 and reference lists from identified studies.

Study selection: 52 English-language studies, 32 of which included primary data.

Data extraction: Data were extracted on study and sample characteristics, interventions, and outcomes. Quality of the diagnostic accuracy studies was evaluated using a published instrument, and quality of the survey studies was evaluated with metrics assessing population representativeness, instrument development, and response rates.

Data synthesis: The positive predictive value of pelvic examination for detecting ovarian cancer was less than 4% in the 2 studies that reported this metric. No studies that investigated the morbidity or mortality benefits of screening pelvic examination for any condition were identified. The percentage of women reporting pelvic examination-related pain or discomfort ranged from 11% to 60% (median, 35%; 8 studies [n = 4576]). Corresponding figures for fear, embarrassment, or anxiety ranged from 10% to 80% (median, 34%; 7 studies [n = 10 702]).

Limitation: Only English-language publications were included; the evidence on diagnostic accuracy, morbidity, and mortality was scant; and the studies reporting harms were generally low quality.

Conclusion: No data supporting the use of pelvic examination in asymptomatic, average-risk women were found. Low-quality data suggest that pelvic examinations may cause pain, discomfort, fear, anxiety, or embarrassment in about 30% of women.

Primary funding source: Department of Veterans Affairs.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Review

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Diagnostic Errors
  • Female
  • Genital Diseases, Female / diagnosis*
  • Gynecological Examination* / adverse effects
  • Gynecological Examination* / psychology
  • Humans
  • Mass Screening*
  • Middle Aged
  • Ovarian Neoplasms / diagnosis
  • Pain / etiology
  • Rape
  • Risk Factors