Routine pelvic examination for asymptomatic women: exploring the evidence

BACKGROUND: A routine pelvic examination is often performed as part of a 'well woman' check, in combination with a Pap test, sexually transmitted infection screening, or before commencing the contraceptive pill or hormone therapy. This check is also done at the woman's request, on the understanding that it may screen for ovarian cancer and other pathology. OBJECTIVE: This article reviews the evidence regarding the use of routine pelvic examination in asymptomatic women as a screening test, and if the examination is performed, what information should be imparted to the patient to obtain informed consent. DISCUSSION: Review of the literature indicates that the use of routine pelvic examination as screening for ovarian malignancy (with or without serum CA-125 and ultrasound) cannot be justified due to the low prevalence of the disease and low sensitivity and specificity of the examination. Pelvic examinations may be performed at the time of routine Pap tests to aid in technical issues with the Pap test itself, but are not recommended for screening purposes. There is no evidence to support pelvic examination of asymptomatic women taking hormone therapy or attending for a sexual health check. The performance of pelvic examination at the woman's request must be preceded by thorough gynaecological, medical and family history and after obtaining informed consent from the patient