Article

Pelvic examinations in asymptomatic women: Tipping a sacred cow

Department of Obstetrics, Gynecology & Productive Science, University of California, San Francisco, CA 94143, USA.
Archives of internal medicine (Impact Factor: 13.25). 12/2011; 171(22):2054-5. DOI: 10.1001/archinternmed.2011.567
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    • "), yet most physicians across specialties reported believing that the pelvic examination is a useful tool to screen for gynecologic cancers. Notably, a large proportion of OB/GYNs compared to other providers reported believing that pelvic examinations are effective for ovarian cancer screening; however, pelvic examinations have been associated with an increased rate of false-positive findings (Smith et al., 2009), which may lead to unneeded followup tests or surgery, causing concern among women about conditions that would have resolved on their own (Sawaya, 2011). Harms of the pelvic examination are not only related to cancer screening. "
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    ABSTRACT: To examine physicians' beliefs about the pelvic examination and identify physician characteristics associated with routine use of this procedure in the United States. A total of 1250 United States family/general practitioners, internists, and obstetrician/gynecologists who participated in the 2009 DocStyles survey completed questions on beliefs regarding the utility of routine pelvic examinations for cancer screening. The survey also asked participants how often they performed this procedure as part of a well-woman exam, to screen for ovarian and other gynecologic cancers, to screen for sexually transmitted infections, and as a prerequisite for prescribing hormonal contraception. A total of 68.0% of obstetrician/gynecologists, 39.2% of family/general practitioners, and 18.7% of internists reported routinely performing pelvic examinations for all the purposes examined (<0.001). Adjusted analyses revealed that the factors most strongly associated with use of pelvic examinations for all purposes were being an obstetrician/gynecologist (odds ratio 8.5; 95% confidence interval 5.8-12.6) and believing that this procedure is useful to screen for gynecologic cancers (odds ratio 3.8; 95% confidence interval 2.6-5.5). Misconceptions about the utility of pelvic examinations to screen for gynecologic cancers are common. More effective strategies to change physicians' beliefs regarding the value of performing pelvic examinations in asymptomatic women are needed.
    Preventive Medicine 03/2012; 54(6):415-21. DOI:10.1016/j.ypmed.2012.03.012 · 2.93 Impact Factor
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    ABSTRACT: Adolescents' experiences of their first pelvic examination (external inspection, speculum examination and bimanual palpation) may have a marked influence on future experiences; why examination techniques and strategies for creating a positive experience of this situation need to be developed. This review addresses to what extent that ambition is reflected in recent literature. The majority of articles on 'pelvic examination during adolescence' come from the United States, which skews the review's perspective. Several researchers recommend using investigations based on new technology rather than a pelvic examination when medical indications for a full examination are present. The profession's attitudes toward annual check-ups and pelvic examinations (in the United States) are currently debated, for teens as well as for adults.How to perform a first pelvic examination on an adolescent is not often discussed, nor are strategies for creating a positive experience of this event.The contexts in which a first pelvic examination is performed probably differ among societies. The Swedish and the US contexts are compared as an illustration; for example preventive healthcare and sex education is in Sweden the responsibility of schools, open for anybody and without admission fees. Recent literature does not mirror a need for developing examination techniques and strategies for creating a positive experience of the first pelvic examination, nor for exploiting its maximal potential as a positive rite of passage.The ongoing US debate on indications for pelvic examinations and annual check-ups is even more relevant for adolescents, in whom contraindications need to be considered.
    Current opinion in obstetrics & gynecology 10/2013; 25(5):357-63. DOI:10.1097/GCO.0b013e3283642b8a · 2.37 Impact Factor
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    ABSTRACT: Objective With newer recommendations for less frequent cervical cancer screening, longer intervals between routine gynecologic examinations might also be considered. Methods A nationally-representative mailed survey of U.S. obstetrician-gynecologists (n = 521, response rate 62%) was conducted in 2010–11. Clinicians were asked their views on annual gynecologic examinations and on the consequences of extending the interval from annually to every 3 years for asymptomatic patients. Results Over two-thirds considered annual gynecologic examination very important for women in their reproductive years (69%); fewer consider it very important for women in menopause (55%). Most anticipated that shifting examinations to every 3 years would result in lower patient satisfaction (78%), contraceptive provision (74%), and patient health and well-being (74%). Decreases in clinic volume (93%) and financial reimbursement (78%) were also expected. Anticipated effects of longer intervals varied by provider characteristics, geography, and practice setting. Conclusion Obstetrician-gynecologists in the U.S. believed longer intervals between routine examinations would have negative repercussions for patients and medical practice, but there were differences by region, practice, and personal characteristics. Redefining annual gynecologic visits as contraceptive counseling and health maintenance visits could address financial and patient volume concerns, and perspectives from patients and other providers might reveal possible benefits of less frequent gynecologic examinations.
    Preventive Medicine 05/2014; 62. DOI:10.1016/j.ypmed.2014.02.004 · 2.93 Impact Factor
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