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
Source: PubMed
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    ABSTRACT: •Bimanual examinations are not an effective screening tool in asymptomatic well women.•The bimanual exam is not recommended for cancer screening, sexually transmitted infection testing, or prior to initiation of contraception.•Clinicians continue to perform the bimanual exam despite evidence-based rationale as to its futility.•The greatest harm generated by pelvic exams is the detection of false-positive pathology.
    The Journal for Nurse Practitioners 09/2014; 10(8). DOI:10.1016/j.nurpra.2014.06.009
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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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    ABSTRACT: To describe obstetrician-gynecologists' beliefs regarding the importance of pelvic examination (including external genitalia inspection, speculum examination, bimanual examination) in assessing hormonal contraception eligibility.
    Contraception 06/2014; DOI:10.1016/j.contraception.2014.06.038 · 2.93 Impact Factor