Women’s health is an important issue to the USPSTF. In response to a topic nomination from the public, the Task Force is commissioning a review of the evidence on the benefits and harms of performing routine periodic pelvic examinations to screen for gynecological conditions. The research approach that will guide this evidence review is described below. To focus the review on information that will be most helpful to primary care clinicians, the USPSTF will concentrate on the following: conditions identified by clinicians as a reason for performing the screening pelvic examination; conditions for which detection of early-stage disease in asymptomatic patients is biologically and clinically plausible; and conditions for which there is not already another method of screening addressed by a current USPSTF recommendation. This review will focus on nonpregnant women age 18 years and older. Adolescents and pregnant women will not be included in the review because pelvic examinations performed in these populations are often for a different indication than those outlined above. The review will focus on the following components of the pelvic examination: 1) inspection of the external genitalia, urethral meatus, vaginal introitus, and perianal region; 2) speculum examination of the vagina and cervix; and 3) bimanual examination of the uterus, cervix, and adnexa. Congenital malformations, such as Müllerian duct anomalies, will be excluded because they are often detected upon initial examination and are not the focus of periodic pelvic examinations. Lastly, the review will focus on asymptomatic women at average risk for these conditions. Women with symptoms of disease and women at increased risk for disease (such as BRCA mutation carriers who are at increased risk for ovarian cancer) will be excluded, as these women may need a diagnostic examination or more intensive surveillance than a routine periodic pelvic examination. The USPSTF welcomes your comments on this proposed research approach.

1. a. What is the effectiveness of screening with the pelvic examination in reducing all-cause mortality?
    b. What is the effectiveness of screening with the pelvic examination in reducing cancer- and disease-specific morbidity and     mortality?
    c. What is the effectiveness of screening with the pelvic examination in improving quality of life?
2. What is the accuracy of the pelvic examination (i.e., sensitivity, specificity, positive and negative predictive values) in screening for gynecological cancers and other gynecological conditions?
3. What are the adverse effects of screening for gynecological conditions with the pelvic examination?

The proposed Research Approach identifies the study characteristics and criteria that the Evidence-based Practice Center will use to search for publications and to determine whether identified studies should be included or excluded from the Evidence Review. Criteria are overarching as well as specific to each of the key questions (KQs).