What are the guidelines for a well-woman (gynecologic) examination?

From the Guidelines

Pelvic examinations are not recommended as a routine part of well-woman visits for asymptomatic, nonpregnant, adult women.

Guidelines for Well-Woman Examination

The American College of Physicians (ACP) found no evidence that screening pelvic examination in asymptomatic, nonpregnant, adult women provides any benefit and indirect evidence that it does not reduce morbidity or mortality rates 1.

• The ACP recommends against routine pelvic examination as part of the well-woman visit, as it is considered low-value care that exposes women to unnecessary and avoidable harms, including fear, anxiety, embarrassment, pain, and discomfort 1.
• Many organizations, including the ACP, advise against screening pelvic examination before prescribing hormonal contraception for healthy asymptomatic women, as it is not supported by evidence 1.
• The recommended cervical cancer screening examination should be limited to visual inspection of the cervix and cervical swabs for cancer and human papillomavirus, and should not entail a full pelvic examination 1.
• Nucleic acid amplification tests on self-collected vaginal swabs or urine have been shown to be highly specific and sensitive for screening for chlamydia and gonorrhea, and can replace the need for a speculum examination 1.

Costs and Harms

• The estimated total annual cost of preventive gynecologic examinations and associated laboratory and radiologic services in the United States is $2.6 billion 1.
• False-positive screening results can lead to unnecessary laparoscopies or laparotomies, adding to the costs and harms of screening pelvic examinations 1.

Exceptions

• Full pelvic examination with bimanual examinations is indicated in some nonscreening clinical situations, such as when a woman is experiencing symptoms or has a history of gynecologic cancer 1.

From the Research

Guidelines for a Well-Woman Examination

The guidelines for a well-woman examination are outlined in several studies, including 2, 3, 4, 5, 6. The key components of a well-woman visit include:

• Taking a comprehensive history, including detailed information on symptoms and past medical and gynecologic history
• Conducting a physical examination, which may include breast or pelvic examination, based on the patient's history and risk factors
• Using family history as a risk assessment tool and updating it regularly
• Developing and discussing a reproductive life plan with reproductive-aged women
• Providing counseling on maintaining a healthy lifestyle and minimizing health risks

Components of the Well-Woman Visit

The components of the well-woman visit are summarized in 4 and include:

• Age-specific recommendations for well-woman health care
• Evidence-based guidelines for preventive health care
• Uniform expert agreement on the components of the well-woman visit
• Identification of needs across a woman's lifespan

Preventive Care in Women's Health

Preventive care in women's health is discussed in 5 and includes:

• Incorporating preventive approaches in the annual well-woman visit
• Identifying key elements of the well-woman examination
• Providing examples of prevention focused on major health care issues that affect adult women

Well-Woman Chart

The Well-Woman Chart, developed by the Women's Preventive Services Initiative, is summarized in 6 and includes:

• Current recommendations for preventive health services for women from adolescence to adulthood
• Clinical guidelines from the U.S. Preventive Services Task Force, Bright Futures, and the Women's Preventive Services Initiative
• Structure based on age intervals and pregnancy status categories
• Target audience of clinicians providing preventive health care for women and patients affected by the recommendations