utility of routine pelvic exams

[honeyyygirl]

"My mom, an MD herself, shared the sentiment expressed in this article. No symptoms...no exams. She had no risk factors. When symptoms finally did present themselves, her pelvic exam revealed a large mass that turned out to be uterine cancer (there are other killers besides ovarian!). I lost my mom when I was only 19. Try looking into my eyes and explaining why we should be discouraging routine pelvic exams."-- top comment on the article.


this is why we do routine pelvics including routine bi-manuals.

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[Rendar5]

"My mom, an MD herself, shared the sentiment expressed in this article. No symptoms...no exams. She had no risk factors. When symptoms finally did present themselves, her pelvic exam revealed a large mass that turned out to be uterine cancer (there are other killers besides ovarian!). I lost my mom when I was only 19. Try looking into my eyes and explaining why we should be discouraging routine pelvic exams."-- top comment on the article.


this is why we do routine pelvics including routine bi-manuals.

And routine whole body CT scans and MRI scans and yearly colonoscopies and routine prostate biopsies? anecdotes don't make things into best accepted practices.

 

[ijn]

Bear in mind that the NY times isn't exactly where doctors should be getting their info. there were a Couple of very good articles in the New England Journal a couple of years back bemoaning the death of the physical exam that are worth a read. That people aren't learning to do exams properly isn't a reason to dismiss them, it's an argument to teach them better. and the notion that exams are problematic because they can net actual findings which are "mostly" going to turn out to be benign and put people through biopsies is so bizarre I don't know if it even merits a response. A finding that turns out to be benign is okay as long as once in a while there is a finding that isn't, and saves someone's life. Most patients would undergo the discomfort of biopsy (which is an outpatient procedure, not surgery) to avoid even the very remote chance they have something bad. That the doctor is talking about taking patients to the OR is misleading.

We have more hysterectomies here because we have more extensive use of imaging and catch more cancers here. People go through life with undetected and/or indeterminate lesions elsewhere. Most won't kill you. Here you aren't playing the odds, and that's probably a good (albeit expensive) thing. A relatively small percentage of these hysterectomies in the US are completely benign and not related to symptoms.

You don't biopsy suspected ovarian cancer. You do a laparoscopy/laparotomy and remove the ovary whole. If you find that bizarre I can't help you. There is no less invasive non-surgical biopsy step. If there were we'd be doing it already. Screening the general population for ovarian cancer does not lower mortality and causes more harm than it helps. These aren't complex concepts.

But continue. We do the annual bimanuals because we have always done the annual bimanuals. Do not ask why. Just do. Now the point of the physical exam isn't to help your patient. It's just to maintain appearances.

 

[ijn]

"My mom, an MD herself, shared the sentiment expressed in this article. No symptoms...no exams. She had no risk factors. When symptoms finally did present themselves, her pelvic exam revealed a large mass that turned out to be uterine cancer (there are other killers besides ovarian!). I lost my mom when I was only 19. Try looking into my eyes and explaining why we should be discouraging routine pelvic exams."-- top comment on the article.


this is why we do routine pelvics including routine bi-manuals.

My mom died secondary to complications from her laparotomy for a benign teratoma found by her over zealous gynecologist on bimanual exam. I was 17 years old. You try looking into my face and telling me my wife should get a bimanual too.

This is why we do population level studies and don't practice medicine on the basis of emotional anecdotes. The evidence is clear. Don't screen for ovarian cancer in the general population.

 

[KnuxNole]

You don't biopsy suspected ovarian cancer. You do a laparoscopy/laparotomy and remove the ovary whole. If you find that bizarre I can't help you. There is no less invasive non-surgical biopsy step. If there were we'd be doing it already. Screening the general population for ovarian cancer does not lower mortality and causes more harm than it helps. These aren't complex concepts.

But continue. We do the annual bimanuals because we have always done the annual bimanuals. Do not ask why. Just do. Now the point of the physical exam isn't to help your patient. It's just to maintain appearances.

It is interesting to see someone argue with resident like this(coming from a med student!).

 

[evilbooyaa]

Most patients would undergo the discomfort of biopsy (which is an outpatient procedure, not surgery) to avoid even the very remote chance they have something bad. That the doctor is talking about taking patients to the OR is misleading.

As ljn has already stated (twice now in this thread) Ovarian cancer is not biopsied. That's what the bimanual exam is supposed to be screening for. But it's not.

As for honeyyyyyyyyyyyyyyyyyyyygirl, anecdotes are just that - anecdotes. Unfortunately, the commenter's mom had terrible luck. Endometrial cancer is much more common, and >80% of it is caught at stage I because people get abnormal uterine bleeding. Endometrial cancer kills (since it's cancer) but even though the yearly incidence is more than double that of ovarian cancer, Ovarian CA has double the yearly mortality of uterine cancer, because it is generally asymptomatic. Most ovarian CA is caught at Stage III, which is obviously worse than endometrial CA's staging on diagnosis.

http://www.cancer.gov/cancertopics/types/ovarian
http://www.cancer.gov/cancertopics/types/endometrial

For the record: I'm not 100% against annual bi-manuals. I think if patients want them at their annual visits, they should get them for their own peace of mind. If patients don't want them (after being properly informed that EBM has shown that they do not benefit the population as a whole) then they shouldn't have to get them. Give the patient an opportunity to make her own decision after giving her the EBM-based information.

 

[ijn]

It is interesting to see someone argue with resident like this(coming from a med student!).

He's a general surgery resident. I just got off of 8 weeks of OB/Gyn clerkship. The last time he probably had to know the management of an ovarian mass was his own third year of medical school.

 

[Dapado33]

“In my experience as a practicing gynecologist, I frequently have had to take patients into the operating room because I found an enlargement during a bimanual pelvic exam,” Dr. Sawaya, a professor of obstetrics at the University of California, San Francisco, said in an interview.

“I then follow up with a sonogram which shows a mass, but I can’t tell what the mass is without surgical exploration. Yet nearly always it’s benign.”

Well then I guess it's nearly ok to not do the physical exam.

 

[MrBeauregard]

My mom died secondary to complications from her laparotomy for a benign teratoma found by her over zealous gynecologist on bimanual exam. I was 17 years old. You try looking into my face and telling me my wife should get a bimanual too.

This is why we do population level studies and don't practice medicine on the basis of emotional anecdotes. The evidence is clear. Don't screen for ovarian cancer in the general population.

Unfortunately for your argument the routine management of a benign teratoma is surgical excision. A physician who takes this management approach is not being "overzealous".

 

[ijn]

Unfortunately for your argument the routine management of a benign teratoma is surgical excision. A physician who takes this management approach is not being "overzealous".

If you know it's a benign teratoma, sure you can say that's the routine management. But it's just an asymptomatic adnexal mass with inconclusive imaging studies before you slice her open and put the ovary under a microscope. And the management of asymptomatic adnexal masses is far from settled because our imaging/diagnostic tests blow.

 

[evilbooyaa]

He's a general surgery resident. I just got off of 8 weeks of OB/Gyn clerkship. The last time he probably had to know the management of an ovarian mass was his own third year of medical school.

Just finishing up OB/GYN myself as well... will likely forget that ovarian masses aren't biopsied within the next 6 months.

 

[ijn]

Just finishing up OB/GYN myself as well... will likely forget that ovarian masses aren't biopsied within the next 6 months.

I'll never forget only because I know it's (essentially) the same management of testicular mass which hits a bit closer to home. You feel something? Cut that whole mother****er out transinguinally. Do not pass go. No biopsies.

 

[honeyyygirl]

With all due respect mr/ms attending, CT scans and MRIs cost way more than inserting your fingers up into the patients vagina/ uterus and feeling around for masses.
I know anecdotes do not equal evidence based medicine but if taking two extra minutes to feel around for masses will prevent anecdotes like that then sorry I'm not sorry.

I'm not posting here to "outsmart" any one or troll and I know my arguments aren't law school tier but I think it's reasonable for an ob/gyn, family med doc to do routine bimanuals. The end !

 

[evilbooyaa]

With all due respect mr/ms attending, CT scans and MRIs cost way more than inserting your fingers up into the patients vagina/ uterus and feeling around for masses.
I know anecdotes do not equal evidence based medicine but if taking two extra minutes to feel around for masses will prevent anecdotes like that then sorry I'm not sorry.

I'm not posting here to "outsmart" any one or troll and I know my arguments aren't law school tier but I think it's reasonable for an ob/gyn, family med doc to do routine bimanuals. The end !

LJN (and I guess myself as well) are not recommending routine CTs/MRIs for screening. Data shows that at a population level, screening for ovarian cancer does more harm than good in asymptomatic patients because of the benign conditions that are generally found, then operated on without knowing whether it is malignant or not. I agree that I would recommend routine bimanuals to the women in my life because I don't want them to become the anecdotes, but I don't think it's something that has to be done every visit, especially if the patient isn't comfortable getting one.

 

[Rendar5]

With all due respect mr/ms attending, CT scans and MRIs cost way more than inserting your fingers up into the patients vagina/ uterus and feeling around for masses.
I know anecdotes do not equal evidence based medicine but if taking two extra minutes to feel around for masses will prevent anecdotes like that then sorry I'm not sorry.

I'm not posting here to "outsmart" any one or troll and I know my arguments aren't law school tier but I think it's reasonable for an ob/gyn, family med doc to do routine bimanuals. The end !

A little sensitive there? My reply did not call for an ******* response. :eyeroll:

 

[TooMuchResearch]

A little sensitive there? My reply did not call for an ******* response. :eyeroll:

Dude, his/her response clearly indicated /thread. Now, lets all get back to placing our fingers in a nearby uterus. The end!

 

[TooMuchResearch]

With all due respect mr/ms attending, CT scans and MRIs cost way more than inserting your fingers up into the patients vagina/ uterus and feeling around for masses.
I know anecdotes do not equal evidence based medicine but if taking two extra minutes to feel around for masses will prevent anecdotes like that then sorry I'm not sorry.

I'm not posting here to "outsmart" any one or troll and I know my arguments aren't law school tier but I think it's reasonable for an ob/gyn, family med doc to do routine bimanuals. The end !

.

 

[Rothbard]

"My mom, an MD herself, shared the sentiment expressed in this article. No symptoms...no exams. She had no risk factors. When symptoms finally did present themselves, her pelvic exam revealed a large mass that turned out to be uterine cancer (there are other killers besides ovarian!). I lost my mom when I was only 19. Try looking into my eyes and explaining why we should be discouraging routine pelvic exams."-- top comment on the article.


this is why we do routine pelvics including routine bi-manuals.

some things to lookup:

positive predictive value
negative predictive value
sensitivity
specificity
risks associated with laparoscopy and laparotomy

 

[Law2Doc]

As ljn has already stated (twice now in this thread) Ovarian cancer is not biopsied...

well, that's not exactly right. You start with the biannual exam. Then you follow it with imaging. If it's highly suspicious for an ovarian cancer then sure the next step could be laparoscopy. However if it's not clear what it is or what organ it's coming from (very frequently the case, particularly if something is already big enough to feel on a physical exam) biopsy would often be the next step. Pelvic masses are frequently biopsied, in this day of image guidance. Sometimes they prove to be ovarian. So yes, doctors do end up doing biopsies in cases that sometimes end up being ovarian cancers.

Also FYI if you follow the first link you provided to the diagnosis section it in fact includes biopsy as part of the diagnosis of ovarian cancer... Nice try.

 

[deuist]

We should just stop the physical exam.

I know you wrote this line in sarcasm, but in reality much of the physical exam has little evidence to support its use. The pelvic exam has been studied in emergency medicine (there was an article in WestJEM) and found to have poor inter-rater reliability, nor did it change management decisions. Similarly, listening to bowel sounds has never been shown to have any clinical utility. Listening for carotid bruits has terrible PPV. And so on. Heck, I've even had a few pneumothoraces with bilateral lung sounds.

 

[Gut Shot]

well, that's not exactly right. You start with the biannual exam. Then you follow it with imaging. If it's highly suspicious for an ovarian cancer then sure the next step could be laparoscopy. However if it's not clear what it is or what organ it's coming from (very frequently the case, particularly if something is already big enough to feel on a physical exam) biopsy would often be the next step. Pelvic masses are frequently biopsied, in this day of image guidance. Sometimes they prove to be ovarian. So yes, doctors do end up doing biopsies in cases that sometimes end up being ovarian cancers.

The pelvic masses that are frequently biopsied tend to intrauterine (accessible through the vagina), intravesicular (accessible through the urethra), and prostatic (accessible transrectally). I don't think I have ever seen someone do an image-guided biopsy of a pelvic mass of undetermined biologic potential - those suckers earn an ex-lap with complete removal and possible staging. Perhaps you are thinking of endometrial biopsies that reveal cancer of ovarian origin?

Also FYI if you follow the first link you provided to the diagnosis section it in fact includes biopsy as part of the diagnosis of ovarian cancer... Nice try.

It describes an ex-lap with excision and pelvic washing, which is a far cry from an image-guided needle biopsy.

Biopsy: A biopsy is the removal of tissue or fluid to look for cancer cells. Based on the results of the blood tests and ultrasound, your doctor may suggest surgery (a laparotomy) to remove tissue and fluid from the pelvis and abdomen. Surgery is usually needed to diagnose ovarian cancer. To learn more about surgery, see the "Treatment" section.

 

[tco]

So I'm going to start rejecting evidence based medicine and do **** in my practice simply because that's the way it's always been done?

I might start believing in God and start voting Republican too, I suppose. I wouldn't bet on it.

There is some evidence based medicine for routine bimanual exam. The USPSTF isn't the only organization out there that provides recommendations, and often the ones they provide are not followed by docs. Most OB/GYNs follow ACOG's recs.

As for "taking a patient to the OR because of a mass seen on ultrasound...It usually ends up being benign..." What a load of bologna. I can't tell you how many "masses" I saw during my OB/GYN rotation that we didn't operate on. Functional cysts are so common in the population that we simply follow them and make sure they go away within a couple of weeks before going to the OR. Scare tactics...

 

[Law2Doc]

The pelvic masses that are frequently biopsied tend to intrauterine (accessible through the vagina), intravesicular (accessible through the urethra), and prostatic (accessible transrectally). I don't think I have ever seen someone do an image-guided biopsy of a pelvic mass of undetermined biologic potential - those suckers earn an ex-lap with complete removal and possible staging. Perhaps you are thinking of endometrial biopsies that reveal cancer of ovarian origin?...

that you have seen them doesn't mean they don't exist. Do a google search of percutaneous image guided biopsy of pelvic masses. The specialties that access through the vagina, urethra and rectum do a minority of the biopsies done on pelvic masses, so if that's what youve been exposed to you are barking up the wrong specialties.

 

[45408]

The problem is not the exam. The problem is not knowing what to do with the findings of the exam.

Also, Law2Doc is not in general surgery. He's specializing in <redacted>.

 

[tco]

The problem is not the exam. The problem is not knowing what to do with the findings of the exam.

I agree with that completely. We're talking about dealing with populations with these exams, but we have to also think about how populations deal with the results of the exams. If the majority of OB/GYNs are following with U/S until they can determine the most likely etiology of the mass, then doing surgery only if it's absolutely necessary (which is exactly what I saw during my 8 weeks), I see no problem with it. However, if we've got a huge population of "cut first, ask questions later," that's much more problematic.

 

[badasshairday]

Also, Law2Doc is not in general surgery. He's specializing in <redacted>.

You know what field he is in????? I've always wondered. I think he is radiology, or maybe he is IM.

 

[Gut Shot]

that you have seen them doesn't mean they don't exist.

I'm not saying they don't exist, but I do not think they are normally part of the workup for a pelvic mass of undetermined biologic potential.

Do a google search of percutaneous image guided biopsy of pelvic masses.

Like this? http://www.ajronline.org/doi/full/10.2214/AJR.05.1393 In my experience the vast majority of percutaneous biopsies of pelvic tissue are done in patients with known malignancy, which is a different kettle of fish.

The specialties that access through the vagina, urethra and rectum do a minority of the biopsies done on pelvic masses, so if that's what youve been exposed to you are barking up the wrong specialties.

If you consider endometrial biopsies, bladder biopsies, and prostate biopsies to be a minority of what gets sampled within the pelvis, I suggest you get out more often.

 

[DoctwoB]

Do understand the difference between an individual and a population?

You're quoting anecdotal evidence. The USPSTF draws upon thousands in a representative sample. Your handful of examples in no way begin to rebut their recommendation.

But hey, no one is forcing you to follow their recommendations. You can do whatever the hell you want out in practice. Just realize you don't have any evidence to justify what you're doing.

Correction. The USPSTF draws upon whatever sample they choose. I too made the mistake of assuming that their assertions were based on solid evidence. Then I read the underlying studies behind their recommendation against PSA screening.

They look at the data from the PLCO study, which was a smaller study in which almost half of the patients in the "do not screen" arm actually received screening and cherry picked out the intention to treat analysis (and even that showed a non-significant trend towards reduced cancer mortality). They completely ignored the larger and more methodologically sound ERSPC study, which found that 1 life could be saved for every 1000 people screened (and this is at 10y of followup. Prostate Ca kills slowly so the benefit at 20y will be even higher). This is comparable to the number needed to screen to prevent death from colon or breast cancer, and a PSA test is a hell of a lot easier/cheaper then a mammogram or colonscopy.

TLDR: The USPSTF is an organization with an agenda biased towards cost reduction, not patient outcomes. Take their recommendations with a grain of salt, and I urge you to look at the data yourself and draw your own conclusion. Or even better, present a simplified version of the data to your patients and let them choose.

 

[Gut Shot]

and I urge you to look at the data yourself and draw your own conclusion.

I spent a little time looking at the two studies. The ERSPC indeed looks much tighter, whereas the PLCO is a "wild west" analysis. The underlying problem might be that our health care system is itself a wild west, so the theoretical benefits of screening derived from a controlled study may not manifest when put into practice in this country.

Here is a nice editorial that compares and contrasts the two:
http://www.prostates.com.au/wp-cont...creening-Studies_What-Are-the-Differences.pdf

 

[Wilf]

So I'm going to start rejecting evidence based medicine and do **** in my practice simply because that's the way it's always been done?

I might start believing in God and start voting Republican too, I suppose. I wouldn't bet on it.

Once you mature, you probably will.

 

[ijn]

Once you mature, you probably will.

Doubt it. I like my abortions legal and politicians to not be mouth breathing young earth creationist southern baptists. Kthx, mkay?

 

[Wilf]

Doubt it. I like my abortions legal and politicians to not be mouth breathing young earth creationist southern baptists. Kthx, mkay?

That's why I said when you mature. I too like abortion to be legal and for the religious to not have too much power. That's no reason not to vote Republican.

 

[ijn]

That's why I said when you mature. I too like abortion to be legal and for the religious to not have too much power. That's no reason not to vote Republican.

I live in the deep south. The republican politicans I would have to vote for are 100% against abortion and are without exception backwards evangelical inbreds. That's more than enough reason to not vote for your party.

 

[Wilf]

I live in the deep south. The republican politicans I would have to vote for are 100% against abortion and are without exception backwards evangelical inbreds. That's more than enough reason to not vote for your party.

Well if this country goes socialist I and many others will probably go to other socialist countries. If I have to live under socialism, this is not the country I would choose. America being more capitalist than most developed countries is why people love it.

 

[ijn]

Well if this country goes socialist I and many others will probably go to other socialist countries. If I have to live under socialism, this is not the country I would choose. America being more capitalist than most developed countries is why people love it.

Good riddance. I actually love my country. I don't plan on throwing a temper tantrum and threaten to break up just because my party lost an election or two. Weren't you going on about maturity just a minute ago?

 

[Wilf]

Good riddance. I actually love my country. I don't plan on throwing a temper tantrum and threaten to break up just because my party lost an election or two. Weren't you going on about maturity just a minute ago?

America or Sweden? America or France? America or Italy? America or Switzerland? America or Ireland?
None of these are tough choices if America is socialist. It's not about having a temper.

 

[ijn]

America or Sweden? America or France? America or Italy? America or Switzerland? America or Ireland?
None of these are tough choices if America is socialist. It's not about having a temper.

Italy? Really dude? Open a newspaper once in a while. Enjoy your nepotistic paradise under Berlusconi...

And yes, it's an easy choice. I'd much rather live in America. You sound like a petulant child throwing a fit because he didn't the toy he wanted at the store. Grow the heck up.

 

[KnuxNole]

America or Sweden? America or France? America or Italy? America or Switzerland? America or Ireland?
None of these are tough choices if America is socialist. It's not about having a temper.

Except having to learn an entire new language. Unless they are cool with me speaking English 100% of the time...which I doubt

And...this topic took a nasty political turn

 

[tco]

No one cares about either of your political views.

 

[Wilf]

No one cares about either of your political views.

That's hard to say, but I do not think most even slightly successful people in this country will actually like socialism if we allow it to keep creeping in. Even Bill Maher is starting to become enlightened in this respect. He said if democrats continue to raise taxes in California they might even lose him. He also said that we have too many people in the cart and not enough people pulling it. These are simple ways to express an important message.

 

[VisionaryTics]

No one cares about either of your political views.

 

[Mass Effect]

.

 

[ijn]

Same can be said for breast exams. No, we don't remove the whole breast, but there's always risk to the biopsy. There's a reason we still do them anyway.

no, comparing breast mass biopsies with ovarian mass biopsies is silly. yes both patients have a vagina and XX chromosomes, but otherwise there is little similar in the overarching oncologically sound management of said patients. the equivalent would be sticking a biopsy needle in a breast cancer and then swishing it around their bone marrow or lungs. ovarian cancer loves the pertioneum. exposing it to that environment is a horrible idea.

 

[bashir]

I just want to add what I would have thought (before reading this thread) would be an uncontroversial statement: the discomfort caused to the patient by a given exam maneuver should weigh in to the cost-benefit analysis of performing the test. I think we need to acknowledge that the bimanual exam itself is invasive and rather traumatic for many women even when performed skillfully, and that this should matter to us.

You listen to a patient's bowel sounds even knowing that it's been found to have no clinical utility? No harm done. You insist on performing a bimanual pelvic examination with no usefulness for clinical decision-making? She will experience discomfort, possibly pain, sometimes humiliation. If the evidence showed a clear survival benefit, that would far outweigh the discomfort in most women's estimation, but sadly it doesn't. The threshold for deciding that an invasive exam is a worthwhile screening test needs to be higher than "it takes little of the doctor's time and costs nothing," which some posters have suggested is enough reason to perform annual bimanuals on asymptomatic women.

 

[Wordead]

That's hard to say, but I do not think most even slightly successful people in this country will actually like socialism if we allow it to keep creeping in. Even Bill Maher is starting to become enlightened in this respect. He said if democrats continue to raise taxes in California they might even lose him. He also said that we have too many people in the cart and not enough people pulling it. These are simple ways to express an important message.

Most people are fine with capitalism. It's the rest of the republican party's stances which exclude normal, rational people. Socialism is the lesser evil compared to the rest of what the party advocates.

 

[evilbooyaa]

that you have seen them doesn't mean they don't exist. Do a google search of percutaneous image guided biopsy of pelvic masses. The specialties that access through the vagina, urethra and rectum do a minority of the biopsies done on pelvic masses, so if that's what youve been exposed to you are barking up the wrong specialties.

Biopsy

The only way to determine for certain if a growth is cancer is to remove a sample of the growth from the suspicious area and examine it under a microscope. This procedure is called a biopsy. For ovarian cancer, the biopsy is most commonly done by removing the tumor.

In rare cases, a suspected ovarian cancer may be biopsied during a laparoscopy procedure or with a needle placed directly into the tumor through the skin of the abdomen. Usually the needle will be guided by either ultrasound or CT scan. This is only used in patients who cannot have surgery because of advanced cancer or some other serious medical condition, because there is concern that a biopsy could spread the cancer..

In patients with ascites (fluid buildup inside the abdomen), samples of the fluid can also be used to diagnose the cancer. In this procedure, called paracentesis, the skin of the abdomen is numbed and a needle attached to a syringe is passed through the abdominal wall into the fluid in the abdominal cavity. The fluid is sucked up into the syringe and then sent for analysis in order to determine if it contains cancer cells.

In all these procedures, the tissue or fluid obtained is sent to the laboratory. There it is examined under the microscope by a pathologist, doctors who specialize in diagnosing and classifying diseases by examining cells under a microscope and using other lab tests.

Source: http://www.cancer.org/cancer/ovariancancer/detailedguide/ovarian-cancer-diagnosis

Pelvic mass != Ovarian mass. Standard modalities for diagnosis of ovarian cancer = Physical Exam, U/S, possibly CT/MRI.

As for the political argument - quit it. This is not the forum or the thread for crap like that. Thanks.

 

[PregnantAt51]

It's certainly worth considering if there is evidence that such exams discourage women from seeking appropriate medical care.

Although this is an old thread, I thought participants might want to hear a patient who has avoided appropriate medical care for decades because of coerced pelvic exams. In fact, I'm not certain what medical care is appropriate since the pelvic exam was demanded, but actually not necessary for the prescription of hormonal birth control.

Embarrassment is an excellent reason to respect a patient's wishes and omit segments of the assessment process, as long as the patient is willing to take responsibility for what information may be unattainable because of the refusal. Pelvic exams can feel degrading, sexually-charged and humiliating to many patients.

We understand that practitioners are comfortable with the processes involved. That doesn't help the patient to feel any less exposed and violated.

It's certainly worth considering if there is evidence that such exams discourage women from seeking appropriate medical care.

 

[evilbooyaa]

Although this is an old thread, I thought participants might want to hear a patient who has avoided appropriate medical care for decades because of coerced pelvic exams. In fact, I'm not certain what medical care is appropriate since the pelvic exam was demanded, but actually not necessary for the prescription of hormonal birth control.

Embarrassment is an excellent reason to respect a patient's wishes and omit segments of the assessment process, as long as the patient is willing to take responsibility for what information may be unattainable because of the refusal. Pelvic exams can feel degrading, sexually-charged and humiliating to many patients.

We understand that practitioners are comfortable with the processes involved. That doesn't help the patient to feel any less exposed and violated.

I think that female patients going to an OB/GYN for their yearly check-up should be able to decline a routine pelvic exam, just like every other aspect of the physical exam. The physician should then document that in the chart so they can't get sued for malpractice.

Just read the thread again - that's what I said all that time ago as well. Sucks ijn got banned. He was a bit arrogant, but was a good poster IMO.

 

[touchpause13]

The thing is, for most women, getting prescription bc is damn near impossible without the pelvic/pap if you are do for that as well. Is there a reason why a pelvic must be done each year for women on bc? I've always wondered if it's just screening for other stuff or if it has anything to do with hormonal birth control.

Sorry if that's a stupid question

 

[mvenus929]

The thing is, for most women, getting prescription bc is damn near impossible without the pelvic/pap if you are do for that as well. Is there a reason why a pelvic must be done each year for women on bc? I've always wondered if it's just screening for other stuff or if it has anything to do with hormonal birth control.

Sorry if that's a stupid question

The guidelines actually now say that a pap should only be done after the age of 21 and once every 2-3 years.

But in a teenage/young adult population, I think it's fairly common to do a pelvic exam and test for gonorrhea/chlamydia if there's any new partners or a concern for it. As far as I know, there's no reason to do it because of hormonal birth control.