Is the annual gynecological exam necessary?

Abstract

Session presented on: Tuesday, November 19, 2013: Background: The concept of an annual gynecological screening visit to identify disease at an early stage at which an intervention is more effective is an established component of women's health care. Both patients and providers have accepted this schedule of visits as important and the gynecological exam as integral to the visit. However, there is little evidence to support the benefits of routine annual pelvic exams in low risk women. The components of the wellness visit can be better aligned with health improvement priorities of Healthy People and the IOM report on Clinical Preventive Services for Women. Purpose: The purpose of this presentation is to identify evidenced-based research to guide the nurse in critically appraising approaches to providing cost effective, safe, evidenced-based care in the context of the women's annual wellness exam. Methods/Results: The first presentation will review current recommendations from professional organizations for screening during the well woman visit. In addition, the presentation will review what is known about the extent to which physicians and advanced practice nurses have adopted such changes into their practice. The second presentation will focus on the evidence or lack thereof of specific components of the gynecological screening pelvic exam. The third presentation articulates components of an evidence-based, revised wellness visit exam using primary prevention of unintended pregnancy and reproductive life planning. To illustrate, case studies from other countries of a redesigned annual wellness visit both within women's health specialty care and primary care visits are discussed. Conclusion: The nursing profession has a long history of incorporating evidenced-based science into daily practice and of challenging long accepted patterns of providing care. A critical appraisal and re-design of the structure of the annual gynecological wellness exam can potentially strengthen efforts to promote the overall health of women.