Do New Guidelines and Technology Make the Routine Pelvic Examination Obsolete?
Do New Guidelines and Technology Make the Routine Pelvic Examination Obsolete?
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DOI：
10.1089/jwh.2010.2349
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发表时间：
2011-01-01
影响因子：
3.5
通讯作者：
Guiahi, Maryam
中科院分区：
文献类型：
--
作者：
Westhoff, Carolyn L.;Jones, Heidi E.;Guiahi, Maryam
常规盆腔检查是定期妇科检查的核心，作为健康维护的必要组成部分被广泛接受。这项检查对无症状女性有益吗？盆腔检查的理由包括衣原体（或淋病）感染筛查，开始激素避孕前的评估，宫颈癌筛查和卵巢癌的早期发现。目前衣原体和淋病的核酸扩增测试允许使用尿液和自我管理的阴道拭子，大多数妇女更喜欢盆腔检查。盆腔检查结果不影响决定处方或暂停全身激素避孕药;盆腔检查不需要启动这些避孕药。最近的美国妇产科医师学会（ACOG）指南建议减少宫颈筛查的频率，从而减少宫颈筛查的窥器检查频率。在美国，双合诊子宫和卵巢触诊也是常规检查。然而，临床试验数据显示，这些检查并不能导致卵巢癌的早期发现。没有证据表明盆腔检查对早期诊断无症状妇女的其他疾病有好处。窥镜和双合诊检查是不舒服的，许多妇女不喜欢，并在妇女访问期间占用很少的时间。取消对大多数无症状妇女的窥器检查和对所有无症状妇女的双合诊检查，将腾出资源提供经证明有益的服务。过度使用盆腔检查会导致高昂的医疗费用，而不会带来任何补偿性的健康益处。
Routine pelvic examinations are the core of the periodic gynecological examination and widely tolerated as a necessary part of health maintenance. Is this examination beneficial for asymptomatic women? Justifications for the pelvic examination include screening for Chlamydia (or gonorrhea) infection, evaluation before initiation of hormonal contraception, screening for cervical cancer, and early detection of ovarian cancer. Current nucleic acid amplification tests for Chlamydia and gonorrhea permit the use of urine and self-administered vaginal swabs, which most women prefer over a pelvic examination. Pelvic examination findings do not affect the decision to prescribe or withhold systemic hormonal contraception; a pelvic examination is not needed to initiate these contraceptives. Recent American College of Obstetricians and Gynecologists (ACOG) guidelines recommend less frequent cervical screening, thus decreasing the frequency of a speculum examination for cervical screening. Bimanual examinations for palpation of the uterus and ovaries are also routinely performed in the United States. Clinical trial data, however, show these examinations do not lead to earlier detection of ovarian cancer. No evidence identifies benefits of a pelvic examination in the early diagnosis of other conditions in the asymptomatic woman. Speculum and bimanual examinations are uncomfortable, disliked by many women, and use scarce time during a well woman visit. Eliminating the speculum examination from most visits and the bimanual examination from all visits of asymptomatic women will free resources to provide services of proven benefit. Overuse of the pelvic examination contributes to high healthcare costs without any compensatory health benefit.