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No 385 - Indications de l'examen pelvien
Devon Evans1, Susan Goldstein2, Amanda Loewy3
1Winnipeg (Man.) (SOGC).
Journal of Obstetrics and Gynaecology Canada : JOGC = Journal D'Obstetrique Et Gynecologie Du Canada : JOGC
|July 24, 2019
Summary
This clinical opinion clarifies indications for pelvic examinations in women, emphasizing appropriate use for timely diagnosis of treatable conditions. It guides healthcare providers in reducing unnecessary exams while ensuring necessary ones are performed for women's health.
Area of Science:
- Gynecology
- Women's Health
- Clinical Practice Guidelines
Background:
- Recent national statements have questioned the utility of the pelvic examination.
- There is a need to clarify appropriate indications for pelvic examinations in adult women.
- This guideline aims to ensure timely diagnosis of treatable gynecological conditions.
Purpose of the Study:
- To clarify indications for pelvic examinations in women aged 18 and older.
- To provide evidence-based recommendations for symptomatic and asymptomatic women.
- To reduce unnecessary pelvic exams while ensuring timely diagnosis of gynecological conditions.
Main Methods:
- A committee opinion based on a review of relevant literature.
- Literature search conducted in PubMed and Medline using keywords related to pelvic examination.
- Evidence quality assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework.
Main Results:
- Pelvic examination components (visual, speculum, bimanual, rectovaginal) should be tailored to clinical indications.
- Cervical cancer screening via Papanicolaou (Pap) test is effective for asymptomatic women.
- Limited evidence supports routine screening pelvic exams for non-cervical gynecological malignancies or benign conditions in asymptomatic women.
Conclusions:
- Pelvic examinations are indicated for women with gynecological complaints to diagnose benign or malignant diseases.
- While not routinely recommended for asymptomatic women for non-cervical conditions, pelvic exams may offer value when performed with cervical cytology screening.
- Healthcare providers should consider individual patient risk factors and clinical presentation when determining the necessity of a pelvic examination.