I disagree with Tintinalli's...

[DrQuinn]

So I was just reviewing something a few days ago in Tintinalli's... and found this (I am paraphrasing, because its upstairs and I have two days off and am NOT wasting my energy to go get it for SDN's sake):

In vaginal bleeders, one should always do a recto-vaginal exam.

Honestly, I can't remember the last time I did one. Sure, vag, no problem. Rectal? Iffy especially if the Hx is pretty straightforward.

So, I disagree with the book. I said it!

Q

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[EctopicFetus]

I remember when I did my Ob rotation and the text (whose name escapes me) states that a women should have a recto-vaginal exam when a woman has her annual exam. I asked a bunch of my classmates and the bottom line is that only 1 of 6 had ever had that done. I think this is a case of best practices type stuff vs what happens in the real world.

 

[BKN]

So I was just reviewing something a few days ago in Tintinalli's... and found this (I am paraphrasing, because its upstairs and I have two days off and am NOT wasting my energy to go get it for SDN's sake):

In vaginal bleeders, one should always do a recto-vaginal exam.

Honestly, I can't remember the last time I did one. Sure, vag, no problem. Rectal? Iffy especially if the Hx is pretty straightforward.

So, I disagree with the book. I said it!

Q

It's just a book with a chapter written by an academic, often junior. I say, go with what makes sense.

 

[Annette]

I remember when I did my Ob rotation and the text (whose name escapes me) states that a women should have a recto-vaginal exam when a woman has her annual exam. I asked a bunch of my classmates and the bottom line is that only 1 of 6 had ever had that done. I think this is a case of best practices type stuff vs what happens in the real world.

I asked a urogyn who does recto-vag exams why. He said you have a greater chance of finding ovarian masses.

 

[DropkickMurphy]

I asked a urogyn who does recto-vag exams why. He said you have a greater chance of finding ovarian masses.

Wow.....I learned something new

 

[FoughtFyr]

I asked a urogyn who does recto-vag exams why. He said you have a greater chance of finding ovarian masses.

I do them not infrequently. I have found retro cecal appys (granted, still needed a CT to talk the surgeons into the OR), two endometrial nests (exquisite tenderness and "fullness" in pouch of Douglas), and one huge cyst that was causing mechanical constipation.

In short, I'm a believer.

- H

 

[8744]

Personally, I don't trust anything that bleeds for five days and doesn't die.

 

[DrQuinn]

I do them not infrequently. I have found retro cecal appys (granted, still needed a CT to talk the surgeons into the OR), two endometrial nests (exquisite tenderness and "fullness" in pouch of Douglas), and one huge cyst that was causing mechanical constipation.

In short, I'm a believer.

- H

I'm a believer... if its indicated.

Young woman, three days of abnormal vaginal bleeding, no other complaints. T's says do a RV exam. I'm saying no need to.

Now if she comes in with 5# weight loss, some constitutional symptoms, significant pain, or GI complains, sure.

But, man, doin' the six-pack hold on her? I'll hold. She can f/u with her gyney anyways.

Q

 

[FoughtFyr]

I'm a believer... if its indicated.

Young woman, three days of abnormal vaginal bleeding, no other complaints. T's says do a RV exam. I'm saying no need to.

Now if she comes in with 5# weight loss, some constitutional symptoms, significant pain, or GI complains, sure.

But, man, doin' the six-pack hold on her? I'll hold. She can f/u with her gyney anyways.

Q

Oh, I agree with you in that scenario. I've just seen too many folks skip it in the undifferentiated lower abd. pain / pelvic pain in the female of childbearing age. In that setting, I find it useful...

- H

 

[Apollyon]

But, man, doin' the six-pack hold on her? I'll hold. She can f/u with her gyney anyways.

It's funny you mention it that way, because, due to this thread, I was thinking back to all those long years ago when I was a 3rd year student on Ob/Gyn, and I was in my preceptor's office (away from hospital), and he would do annual exams. He always did the RV exam, and I had to laugh, because he did a modified "shocker" ('modified' only because they weren't at the same time).

 

[kungfufishing]

Assuming you have the probe, wouldnt TVUS be better anyway?

 

[DropkickMurphy]

BTW.....I fully intend to put the aforementioned knowledge to use for my own purposes.....

 

[GeneralVeers]

BTW.....I fully intend to put the aforementioned knowledge to use for my own purposes.....

No need to do an U/S on most vag bleeders. If they're not pregnant, have a normal Hct, and an unremarkable pelvic exam they should go home. Dispo in 10 minutes or less.

 

[Apollyon]

Assuming you have the probe, wouldnt TVUS be better anyway?

Looking for what? As EM U/S goes, free fluid and an IUP are what I'm specifically looking for. Beyond that, I'll be the first to tell you that I'm not making any other definitive statements.

 

[bulgethetwine]

BTW.....I fully intend to put the aforementioned knowledge to use for my own purposes.....

Just remember the old adage with the double meaning:

Don't insult the vagina by doing the rectal exam first!

 

[DropkickMurphy]

Just remember the old adage with the double meaning:

Don't insult the vagina by doing the rectal exam first!

 

[lattimer13]

Personally, I don't trust anything that bleeds for five days and doesn't die.

beefcake....beefcake!

gotta love the south park quotes.