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: 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: •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.
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