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ARE GENITAL INSPECTION AND SPECULUM EXAMINATION IN ASYMPTOMATIC WOMEN NECESSARY AND HELPFUL?

Nurse Practitioner

by Mimi Secor, DNP, FNP-BC, FAANP

To perform or not to perform a genital and speculum exams in asymptomatic non-pregnant women? That is a controversial question with no clear answer.
Most clinicians assume genital inspection and speculum examination in asymptomatic women is clinically valuable. Despite these practices being considered routine by most clinicians, research supporting these practices is limited. Because of the lack of documented benefit and the concern of possible harm, the American College of Physicians (ACP) recently recommended against performing routine genital and speculum exams in asymptomatic nonpregnant women. In contrast, although recognizing the lack of supportive evidence, the American College of Obstetricians and Gynecologists (ACOG) guidelines recommend annual genital and speculum examinations in women aged ?21 years old. A recently published study surveyed 521 OB/GYNs about their opinions and more than 90% favored performing routine genital and speculum exams in asymptomatic women (ranging in age from 18-70 years).
Without quality evidence-based guidance, it is this authors recommendation that clinicians involve patients in a shared decision-making process regarding the appropriateness of performing a genital and/or speculum exam in asymptomatic non-pregnant women. This decision should consider clinician and patient concerns, preferences and goals.
Therefore, what do you think about this controversy and what do you do in your practice and why? We would like to hear from you.

Hsu A et al. Obstetrician–gynecologist practices and beliefs regarding external genitalia inspection and speculum examinations in healthy older asymptomatic women. J Am Geriatr Soc 2016 Feb; 64:293. (http://dx.doi.org/10.1111/jgs.13954)
See more at: http://www.jwatch.org/na40591/2016/02/23/are-genital-inspection-and-speculum-examination?query=etoc_jwwomen&jwd=000000393311&jspc=#sthash.jgjZfgXV.dpuf