Contents

Search

pelvic examination

Indications: - suspected gynecologic disease - screening for cervical cancer (no bimanual exam) - USPSTF concludes not enough evidence to recommend for or against routine pelvic examinations in asymptomatic, nonpregnant adult women [5] * excluding screening for cervical cancer Contraindications: - routine exam or screening exams [3] - does not apply to routine screening for cervical cancer - screening for chlamydia or gonorrrhea - use urine GenProbe or self-collected vaginal GenProbe [3] - of no benefit for pregnant women < 16 weeks gestation with vaginal bleeding or abdominal pain [6] Procedure: - bimanual examination of pelvic strucutres including: a) cervix b) uterus c) adnexal structures - ovaries - fallopian tubes - requires explicit consent [7] Notes: - women undergoing pelvic exams should be offered a choice: stirrups or no stirrups [1] - obstetrician-gynecologists commonly perform external & speculum examinations in asymptomatic elderly women & believe the external examination to be particularly important for cancer detection, but but supporting data are limited [4] - hospitals performing pelvic exams with explicit patient consent will not be eligible for Medicare & Medicaid reimbursement [7]

Specific

pelvic examination under anesthesia

General

clinical procedure

References

  1. Seehusen DA, Johnson DR, Earwood JS, Sethuraman SN, Cornali J, Gillespie K, Doria M, Farnell E 4th, Lanham J. Improving women's experience during speculum examinations at routine gynaecological visits: randomised clinical trial. BMJ. 2006 Jul 22;333(7560):171. Epub 2006 Jun 27. PMID: 16803941 - Oakeshott P, Hay P. Best practice in primary care. BMJ. 2006 Jul 22;333(7560):173-4. No abstract available. PMID: 16858046 - Barr WB. Vaginal speculum examinations without stirrups. BMJ. 2006 Jul 22;333(7560):158-9. No abstract available. PMID: 16858019
  2. Digesu GA, Khullar V, Cardozo L, Robinson D. Inter-observer reliability of digital vaginal examination using a four-grade scale in different patient positions. Int Urogynecol J Pelvic Floor Dysfunct. 2008 Sep;19(9):1303-7. PMID: 18458801
  3. Bloomfield HE et al. Screening pelvic examinations in asymptomatic, average-risk adult women: An evidence report for a clinical practice guideline from the American College of Physicians. Ann Intern Med 2014 Jul 1; 161:46. PMID: 24979449 http://annals.org/article.aspx?articleid=1884533 - Qaseem A et al. Screening pelvic examination in adult women: A clinical practice guideline from the American College of Physicians. Ann Intern Med 2014 Jul 1; 161:67. PMID: 24979459 http://annals.org/article.aspx?articleid=1884537 - Sawaya GF and Jacoby V. Screening pelvic examinations: Right, wrong, or rite? Ann Intern Med 2014 Jul 1; 161:78 PMID: 24979453 http://annals.org/article.aspx?articleid=1884541
  4. Hsu A, Henderson JT, Harper CC, Sawaya GF. Obstetrician-Gynecologist Practices and Beliefs Regarding External Genitalia Inspection and Speculum Examinations in Healthy Older Asymptomatic Women. J Am Geriatr Soc. 2016 Feb;64(2):293-8. PMID: 26805728
  5. U.S. Preventive Services Task Force (USPSTF) Draft Recommendation Statement Gynecological Conditions: Screening With the Pelvic Examination. http://www.uspreventiveservicestaskforce.org/Page/Document/draft-recommendation-statement157/gynecological-conditions-screening-with-the-pelvic-examination - Draft Evidence Review Draft Evidence Review for Gynecological Conditions: Screening With the Pelvic Examination. http://www.uspreventiveservicestaskforce.org/Page/Document/draft-evidence-review148/gynecological-conditions-screening-with-the-pelvic-examination - US Preventive Services Task Force Screening for Gynecologic Conditions With Pelvic Examination. US Preventive Services Task Force Recommendation Statement. JAMA. 2017;317(9):947-953 PMID: 28267862 http://jamanetwork.com/journals/jama/fullarticle/2608228 - Guirguis-Blake JM, Henderson JT, Perdue JA et al Periodic Screening Pelvic ExaminationEvidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2017;317(9):954-966 PMID: 28267861 http://jamanetwork.com/journals/jama/fullarticle/2608227 - Sawaya GF Screening Pelvic ExaminationsThe Emperor's New Clothes, Now in 3 Sizes? PMID: 28267832 JAMA Intern Med. Published online March 7, 2017. http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2605478 - McNicholas C, Peipert JF. Is it time to abandon the routine pelvic examination in asymptomatic nonpregnant women? JAMA 2017 Mar 7; 317:910. PMID: 28267835
  6. Linden JA, Grimmnitz B, Hagopian L et al. Is the pelvic examination still crucial in patients presenting to the emergency department with vaginal bleeding or abdominal pain when an intrauterine pregnancy is identified on ultrasonography? A randomized controlled trial. Ann Emerg Med. 2017 Sep 19. pii: S0196-0644(17)31387-2 PMID: 28935285 http://www.annemergmed.com/article/S0196-0644(17)31387-2/fulltext
  7. Merelli A New HHS guidance requires consent for pelvic, breast, and other sensitive examinations. STAT. April 1, 2024 https://www.statnews.com/2024/04/01/informed-consent-pelvic-exam-new-hhs-guidelines/