Obstet Gynecol. 2018 Oct;132(4):1080-1083. doi: 10.1097/AOG.0000000000002896.
The pelvic examination has long been considered a fundamental component of the well-woman visit, and many women and gynecologic care providers view this visit as an opportunity to discuss sexual and reproductive health issues. Traditionally, a pelvic examination is performed for asymptomatic women as a screening tool for gynecologic cancer, infection, and asymptomatic pelvic inflammatory disease; some obstetrician-gynecologists and patients consider it important in detecting subclinical disease, despite evidence to the contrary. Given changes in screening recommendations and the ability to screen for sexually transmitted infections using less-invasive methods, reevaluation of the role of the pelvic examination for asymptomatic, nonpregnant women is warranted. A limited number of studies have evaluated the benefits and harms of a screening pelvic examination for detection of ovarian cancer, bacterial vaginosis, trichomoniasis, and genital herpes. Data from these studies are inadequate to support a recommendation for or against performing a routine screening pelvic examination among asymptomatic, nonpregnant women who are not at increased risk of any specific gynecologic condition. It is recommended by the American College of Obstetricians and Gynecologists that pelvic examinations be performed when indicated by medical history or symptoms. Women with current or a history of cervical dysplasia, gynecologic malignancy, or in utero diethylstilbestrol exposure should be screened and managed according to guidelines specific to those gynecologic conditions. Based on the current limited data on potential benefits and harms and expert opinion, the decision to perform a pelvic examination should be a shared decision between the patient and her obstetrician-gynecologist or other gynecologic care provider.
盆腔检查长期以来一直被认为是妇女健康检查的基本组成部分，许多妇女和妇科保健提供者将此访视视为讨论性和生殖健康问题的机会。传统上，无症状女性进行盆腔检查是一种筛查妇科癌症、感染和无症状盆腔炎的工具；一些妇产科医生和患者认为，尽管有相反的证据，但它在检测亚临床疾病方面很重要。鉴于筛查建议的变化以及使用侵入性较小的方法筛查性传播感染的能力，有必要重新评估无症状、非孕妇进行盆腔检查的作用。少数研究评估了筛查盆腔检查对卵巢癌、细菌性阴道病、滴虫病和生殖器疱疹检测的益处和危害。这些研究的数据不足以支持对无症状、非孕妇进行常规筛查盆腔检查的建议，因为这些妇女没有任何特定妇科疾病的风险增加。美国妇产科医师学会建议，根据病史或症状提示进行盆腔检查。目前或曾经有宫颈发育不良、妇科恶性肿瘤或宫内己烯雌酚暴露史的妇女，应根据特定于这些妇科疾病的指南进行筛查和管理。基于目前关于潜在益处和危害的有限数据和专家意见，进行盆腔检查的决定应该是患者与其妇产科医生或其他妇科保健提供者之间的共同决策。
