Hanna E. Bloomfield, M.D., M.P.H.
Andrew Olson, M.D.
Amy Cantor, M.D., M.H.S.
Nancy Greer, Ph.D.
Roderick MacDonald, M.S.
Indulis Rutks, B.A.
Evidence-based Synthesis Program (ESP) Center, Minneapolis VA Medical Center,
Washington (DC): Department of Veterans Affairs; September 2013
The routine pelvic examination has been a usual part of preventive care for women for many
decades. In 2008, 63.4 million pelvic examinations were performed in the United States. Many
women and providers believe that the routine pelvic exam should be included in an annual
comprehensive well-woman visit. The exam consists of inspection of the external genitalia,
speculum examination of the vagina and cervix, bimanual examination, and sometimes rectal
or rectovaginal examination. Traditionally, the examination in the asymptomatic average risk
women has been used to screen for pathology through palpation, visualization, and specimen
Pathology potentially detectable on the pelvic examination includes malignancies (e.g., cervical,
ovarian, uterine, bladder, vaginal or vulvar); infections (e.g., Chlamydia, gonorrhea, warts,
candidiasis, bacterial vaginosis); pelvic inflammatory disease (PID); or other pathology (e.g.,
atrophic vaginitis, cervical polyps, uterine prolapse, fibroids). In addition, pelvic examinations
are often performed prior to the provision of hormonal contraception. Recent high quality
evidence-based reviews and guidelines have concluded that pelvic examinations are not required
for Chlamydia and gonorrhea screening or for hormonal contraception initiation and up-to-date
evidence-based guidelines for cervical cancer screening are also available. However, we are
unaware of any systematic reviews that have investigated the utility of the pelvic examination for
the other indications.
This systematic review was undertaken to evaluate the benefits and harms of the routine
screening pelvic examination in asymptomatic, average risk, non-pregnant, adult women. For
cervical cancer and sexually transmitted infection (i.e., Chlamydia and gonorrhea) screening
and for initiation of hormonal contraception we summarize the results of recent reviews and
guidelines from major US health organizations. For all other indications, we performed and
report results from a comprehensive search of the medical literature.