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Most OB/GYNs Perform Pelvic Examinations Routinely

Summary and Comment |
March 14, 2013

Most OB/GYNs Perform Pelvic Examinations Routinely

  1. Diane E. Judge, APN/CNP

Nearly all survey respondents would do bimanual pelvic examinations on healthy, asymptomatic women who do not need Pap smears.

  1. Diane E. Judge, APN/CNP

The American College of Obstetricians and Gynecologists recommends annual pelvic exams for healthy, asymptomatic women aged ≥21 (JW Womens Health Aug 23 2012) but acknowledges the lack of evidence about benefits and harms. Researchers conducted a survey in 521 practicing obstetrician-gynecologists (55% men) to ask whether they would routinely conduct bimanual pelvic examinations on asymptomatic women who were not due for Pap smears. The survey included vignettes in four nonpregnant patients: an 18-year-old who recently became sexually active; a 35-year-old with three consecutive normal annual Pap tests and no new sexual partners in the last 5 years; a 55-year-old with total hysterectomy and oophorectomy for benign disease; and a 70-year-old with 30 years of normal Pap tests and no sexual activity in the last 10 years.

Most respondents said they would perform bimanual examinations (87% for the 18-year-old, 99% for the 35-year-old, 96% for the 55-year-old, and 98% for the 70-year-old). Only 36% rated this examination as “very important” for the 18-year-old; 57% rated it very important for the 35- and 55-year-olds; and 69% for the 70-year-old. More than 40% rated the bimanual examination as “very important” for detecting benign uterine or ovarian conditions or ovarian cancer, for patient reassurance, and for adherence to practice standards.

Comment

Opponents of routine pelvic exams consider them a waste of healthcare resources. Proponents, including the editorialist, cite benefits that include detection of vulvar cancers, pelvic organ prolapse (particularly in women with hysterectomies), and symptomatic conditions that women are reluctant to disclose. All survey respondents considered ovarian cancer screening to be “very important.” However, the American College of Obstetricians and Gynecologists does not recommend this practice — and the U.S. Preventive Services Task Force discourages it (JW Womens Health Sept 10 2012). ACOG advises that clinicians and patients share decision making about performing the pelvic examination.

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