Qui et comment examiner ? Tout dépend de l’âge et des atcds !

The recommendations on when to start screening, how often to continue screening, and when to stop routine pelvic examination and cervical cytology are based on age.

For women younger than 21 years who have never been sexually active,

 no routine pelvic examination,

 cervical cytology,

 or testing for sexually transmitted disease (STD) is needed.

If the women have ever been sexually active,

 however, ACOG recommends cervical cytology be performed 3 years after the onset of sexual activity, and annually thereafter.

 Routine pelvic examination should be performed only when indicated by the patient’s medical history.

For women aged 21 to 29 years,

 ACOG recommends an annual pelvic examination and cervical cytology. -Sexually active women aged 25 years or younger should be screened for chlamydia, and all sexually active adolescents should be screened for gonorrhea.

• Urine-based screening without a speculum examination is sufficient for such screening, according to ACOG.

 ACOG also says that all adolescents and women aged 19 to 64 years who are sexually active should be screened for HIV.

For women aged 30 to 64 years

 the recommendation is for annual pelvic examination plus cervical cytology.

 However, screening can be decreased to every 2 to 3 years

• after 3 normal test results

• if the patient has no history of cervical intraepithelial neoplasia (CIN) 2 or CIN3,

• is not immunosuppressed,

• is not HIV-positive,

• and was not exposed to diethylstilbestrol (DES) in utero.

For women older than 65 years,

 ACOG recommends an annual pelvic examination.

 However, cervical cytology may be discontinued

• if the woman has had 3 or more normal test results in a row,

• no abnormal test results in 10 years,

• no history of cervical cancer,

• no DES exposure in utero,

• is HIV-negative and immunocompetent,

• and does not have other risk factors for STDs.

 The need to begin screening again should be evaluated at each annual examination.

The pelvic examination is not a routine part of the annual health examination in girls aged 13 to 18 years,

 unless it is medically indicated.

 It should be performed when it is likely to yield information about

• amenorrhea,

• abnormal bleeding,

• vaginitis,

• pelvic pain,

• an STD,

• a pelvic mass,

• or other conditions.

 It is also reasonable to stop speculum and bimanual pelvic examinations in asymptomatic women who have had

a total hysterectomy and bilateral oophorectomy for benign indications,

although annual examination of the external genitalia should continue.

 It would also be reasonable to stop pelvic examination when a

woman’s age or other health issues reach a point where the woman would not choose to treat conditions

detected during the routine examination. Such a decision should be discussed between the patient and her physician, ACOG recommends.