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Journal of Gynecology Obstetrics and... Feb 2024To analyze the literature and expose best evidence available regarding the benefit of pelvic examination for women with suspected endometriosis METHODS: the AGREE II and... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To analyze the literature and expose best evidence available regarding the benefit of pelvic examination for women with suspected endometriosis METHODS: the AGREE II and GRADE systems for grading scientific evidence.
RESULTS
Endometriosis is characterized by the heterogeneity in its clinical presentation with many different symptoms reported by patients. In the literature, questioning for each symptom has a high sensitivity, reaching 76-98 %, but lacks specificity (20 - 58 %). The symptom-based approach is limited by its low specificity, the absence of external validation for most of the models developed and the inability to characterize the extent of the disease, which could have major implications in the decision - making process. The latest systematic review and meta-analysis included a total of 30 studies with 4,565 participants, compared the diagnostic performance of several modalities for endometriosis. Physical examination had a pooled sensitivity of 71 % and a specificity of 69 %, with an average diagnostic accuracy of 0.76. Overall, the value of pelvic examination is conferred by its high positive likehood ratio and specificity. Besides its diagnostic value, pelvic examination improves patients' management by allowing the identification of a possible myofascial syndrome as a differential diagnosis. It also increases the quality of the preoperative workup and influences the quality of surgical excision and decreases the time to diagnosis.
CONCLUSION
Despite the lack of studies in the primary care context, pelvic examination (vaginal speculum and digital vaginal examination) increases the diagnostic value for suspected endometriosis in association with questioning for symptoms.
Topics: Humans; Female; Endometriosis; Gynecological Examination; Peritoneal Diseases
PubMed: 38224817
DOI: 10.1016/j.jogoh.2024.102724 -
The Australian & New Zealand Journal of... Jun 2019Intrapartum ultrasound has been proposed as a method of assessing labour progress but its acceptability has not been comprehensively assessed. (Observational Study)
Observational Study
BACKGROUND
Intrapartum ultrasound has been proposed as a method of assessing labour progress but its acceptability has not been comprehensively assessed.
AIMS
We evaluated the acceptability of intrapartum ultrasound in women having vaginal examination (VE) and ultrasound (US) assessment (transabdominal (TA) and transperineal (TP)) prior to delivery, with and without regional analgesia (RA).
MATERIALS AND METHODS
Women at 24-42 weeks gestation were included in a prospective observational cohort study. The acceptability of digital VE and TP US were assessed pre- and post-examination using the modified validated Wijma Delivery Experience Questionnaire. Acceptability scores ranged 6-36 (6 being most and 36 being least positive) in six domains: positive-trust and relax, negative-harmful to baby, worrying, painful, intrusive.
RESULTS
Of 119 women recruited, 104 completed both pre- and post-assessment questionnaires. Eighty-nine per cent of women were nulliparous with median gestation 40 + 2 weeks (25-42 ). Thirty-two per cent had RA before assessment, 91% in total. The combined acceptability scores of both negative and positive experiences (6 = most acceptable, 36 = least acceptable) for VE and US pre-assessment were 15 and 7 respectively (P < 0.0001: Mann-Whitney U-test). VE was associated with less positive / more negative domain scoring post-assessment 12 and 6, respectively (P < 0.0001). Although RA made no difference to the perceived experience pre-VE (P = 0.9), post-VE, women with RAs considered VEs more acceptable than those without RA (P = 0.0022).
CONCLUSION(S)
This is the first study to comprehensively assess the acceptability of VE and intrapartum US. US assessment prior to delivery is more acceptable than VE. RA ameliorated the negative experience of the VE post-assessment.
Topics: Adolescent; Adult; Cohort Studies; Female; Gynecological Examination; Humans; Middle Aged; Obstetric Labor Complications; Patient Satisfaction; Pregnancy; Prospective Studies; Surveys and Questionnaires; Ultrasonography, Prenatal; Young Adult
PubMed: 30024022
DOI: 10.1111/ajo.12864 -
JAMA Internal Medicine May 2022Screening for medication abortion eligibility typically includes ultrasonography or pelvic examination. To reduce physical contact during the COVID-19 pandemic, many...
IMPORTANCE
Screening for medication abortion eligibility typically includes ultrasonography or pelvic examination. To reduce physical contact during the COVID-19 pandemic, many clinicians stopped requiring tests before medication abortion and instead screened patients for pregnancy duration and ectopic pregnancy risk by history alone. However, few US-based studies have been conducted on the outcomes and safety of this novel model of care.
OBJECTIVE
To evaluate the outcomes and safety of a history-based screening, no-test approach to medication abortion care.
DESIGN, SETTING, AND PARTICIPANTS
This retrospective cohort study included patients obtaining a medication abortion without preabortion ultrasonography or pelvic examination between February 1, 2020, and January 31, 2021, at 14 independent, Planned Parenthood, academic-affiliated, and online-only clinics throughout the US.
EXPOSURES
Medications for abortion provided without preabortion ultrasonography or pelvic examination and dispensed to patients in person or by mail.
MAIN OUTCOMES AND MEASURES
Effectiveness, defined as complete abortion after 200 μg of mifepristone and up to 1600 μg of misoprostol without additional intervention, and major abortion-related adverse events, defined as hospital admission, major surgery, or blood transfusion.
RESULTS
The study included data on 3779 patients with eligible abortions. The study participants were racially and ethnically diverse and included 870 (23.0%) Black patients, 533 (14.1%) Latinx/Hispanic patients, 1623 (42.9%) White patients, and 327 (8.7%) who identified as multiracial or with other racial or ethnic groups. For most (2626 [69.5%]), it was their first medication abortion. Patients lived in 34 states, and 2785 (73.7%) lived in urban areas. In 2511 (66.4%) abortions, the medications were dispensed in person; in the other 1268 (33.6%), they were mailed to the patient. Follow-up data were obtained for 2825 abortions (74.8%), and multiple imputation was used to account for missing data. Across the sample, 12 abortions (0.54%; 95% CI, 0.18%-0.90%) were followed by major abortion-related adverse events, and 4 patients (0.22%; 95% CI, 0.00%-0.45%) were treated for ectopic pregnancies. Follow-up identified 9 (0.40%; 95% CI, 0.00%-0.84%) patients who had pregnancy durations of greater than 70 days on the date the mifepristone was dispensed that were not identified at screening. The adjusted effectiveness rate was 94.8% (95% CI, 93.6%-95.9%). Effectiveness was similar when medications were dispensed in person (95.4%; 95% CI, 94.1%-96.7%) or mailed (93.3%; 95% CI, 90.7%-95.9%).
CONCLUSIONS AND RELEVANCE
In this cohort study, screening for medication abortion eligibility by history alone was effective and safe with either in-person dispensing or mailing of medications, resulting in outcomes similar to published rates of models involving ultrasonography or pelvic examination. This approach may facilitate more equitable access to this essential service by increasing the types of clinicians and locations offering abortion care.
Topics: Abortion, Induced; Abortion, Spontaneous; COVID-19; Cohort Studies; Female; Humans; Mifepristone; Pandemics; Pregnancy; Pregnancy, Ectopic; Retrospective Studies
PubMed: 35311911
DOI: 10.1001/jamainternmed.2022.0217 -
International Journal of Environmental... Jun 2021Chronic pelvic pain affects approximately 15% of reproductive age women. It is mainly caused by adhesions (20-40%). Despite CPP being the main symptom of endometriosis,...
BACKGROUND
Chronic pelvic pain affects approximately 15% of reproductive age women. It is mainly caused by adhesions (20-40%). Despite CPP being the main symptom of endometriosis, the disease is confirmed by laparoscopy only in 12-18% of cases. The aim of this study was to evaluate the results of laparoscopy in women with CCP and to assess the sensitivity and specificity of elements of an interview and clinical examination.
MATERIALS AND METHODS
The study included 148 women with CPP. Each patient underwent laparoscopy. In laparoscopy, the presence of endometriosis and/or peritoneal adhesions was confirmed. Then, the sensitivity and specificity and the positive and negative predictive value of endometriosis symptoms or abnormalities in the gynecological examination were statistically calculated.
RESULTS
After previous surgery, adhesions were found in almost half (47%) of patients. In patients without a history of surgery, adhesions were diagnosed in 6.34% of patients. Endometriosis without coexisting adhesions was more often diagnosed in women without previous surgery (34.9%), compared to 10.58% in the group with a history of surgery ( < 0.05).
CONCLUSIONS
Intraperitoneal adhesions are most common in women after pelvic surgery and with chronic ailments. The best results for sensitivity, specificity, positive predictive value, and negative predictive value in the diagnosis of endometriosis are found in women with irregular menstruations during which the pain increases. Laparoscopy still remains the primary diagnostic and therapeutic method for these women.
Topics: Endometriosis; Female; Humans; Laparoscopy; Pelvic Pain; Physical Examination; Tissue Adhesions
PubMed: 34205332
DOI: 10.3390/ijerph18126606 -
Annals of Internal Medicine Jul 2014Pelvic examination is often included in well-woman visits even when cervical cancer screening is not required. (Review)
Review
BACKGROUND
Pelvic examination is often included in well-woman visits even when cervical cancer screening is not required.
PURPOSE
To evaluate the diagnostic accuracy, benefits, and harms of pelvic examination in asymptomatic, nonpregnant, average-risk adult women. Cervical cancer screening was not included.
DATA SOURCES
MEDLINE and Cochrane databases through January 2014 and reference lists from identified studies.
STUDY SELECTION
52 English-language studies, 32 of which included primary data.
DATA EXTRACTION
Data were extracted on study and sample characteristics, interventions, and outcomes. Quality of the diagnostic accuracy studies was evaluated using a published instrument, and quality of the survey studies was evaluated with metrics assessing population representativeness, instrument development, and response rates.
DATA SYNTHESIS
The positive predictive value of pelvic examination for detecting ovarian cancer was less than 4% in the 2 studies that reported this metric. No studies that investigated the morbidity or mortality benefits of screening pelvic examination for any condition were identified. The percentage of women reporting pelvic examination-related pain or discomfort ranged from 11% to 60% (median, 35%; 8 studies [n = 4576]). Corresponding figures for fear, embarrassment, or anxiety ranged from 10% to 80% (median, 34%; 7 studies [n = 10 702]).
LIMITATION
Only English-language publications were included; the evidence on diagnostic accuracy, morbidity, and mortality was scant; and the studies reporting harms were generally low quality.
CONCLUSION
No data supporting the use of pelvic examination in asymptomatic, average-risk women were found. Low-quality data suggest that pelvic examinations may cause pain, discomfort, fear, anxiety, or embarrassment in about 30% of women.
PRIMARY FUNDING SOURCE
Department of Veterans Affairs.
Topics: Adult; Aged; Aged, 80 and over; Diagnostic Errors; Female; Genital Diseases, Female; Gynecological Examination; Humans; Mass Screening; Middle Aged; Ovarian Neoplasms; Pain; Rape; Risk Factors
PubMed: 24979449
DOI: 10.7326/M13-2881 -
International Journal of Women's... Jun 2024
PubMed: 38694955
DOI: 10.1097/JW9.0000000000000147 -
Obstetrics and Gynecology Dec 2019We provide an overview of the issue of specific consent for pelvic examinations under anesthesia performed by medical students. Arguments that have historically been...
We provide an overview of the issue of specific consent for pelvic examinations under anesthesia performed by medical students. Arguments that have historically been made against requiring consent for such examinations are reviewed and refuted. The implications of requiring consent for examinations under anesthesia are discussed as they relate to patient autonomy, medical student education, and society at large. Finally, we outline a solution and offer sample language that balances the interests of patients, learners, and society.
Topics: Anesthesia, General; Clinical Clerkship; Education, Medical, Undergraduate; Female; Gynecological Examination; Gynecology; Humans; Informed Consent; Students, Medical; United States
PubMed: 31764742
DOI: 10.1097/AOG.0000000000003509 -
The European Journal of General Practice Dec 2020French general practitioners (GP) and gynaecologists can make use of recommendations when performing a patient's first pelvic examination. The indications and...
French general practitioners (GP) and gynaecologists can make use of recommendations when performing a patient's first pelvic examination. The indications and techniques for this examination are clear. The relational aspects and experience of the patients have been dealt with little. To analyse and understand the experience of French women during their first pelvic examination to propose practice recommendations based on their experiences. Qualitative semi-structured interviews was conducted with 13 French women aged 18-30 years recruited from the surgery of a general practitioner using the snowball method. The data were analysed using an inductive method. The first pelvic examination was considered an indispensable rite of passage into adulthood and the life of a woman. They wanted a preparation for a consultation devoted to the first pelvic examination, with a time that is adapted to each woman. A patient-centred practitioner was more important than the pelvic examination itself. Women requested for a general practitioner or a gynaecologist with a deeper understanding of a woman's experience to perform their first pelvic examination. We propose practical recommendations: the following 3 phases for the consultation: before the pelvic examination where the women and the practitioners may get to know one another; during the examination, which would involve the technical aspects and the associated procedures; and after the examination, where the patients and the practitioners review the experience and discuss prevention.
Topics: Adult; Attitude to Health; Female; France; Grounded Theory; Gynecological Examination; Humans; Physician-Patient Relations; Qualitative Research; Young Adult
PubMed: 32401073
DOI: 10.1080/13814788.2020.1760243 -
International Urogynecology Journal Feb 2021Pelvic floor myalgia is a common cause and contributor to chronic pelvic pain [Neurourol Urodyn 4:984-1008 (2017)]. The purpose of this study was to compare in-person... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
Pelvic floor myalgia is a common cause and contributor to chronic pelvic pain [Neurourol Urodyn 4:984-1008 (2017)]. The purpose of this study was to compare in-person versus video-based teaching methods of a comprehensive assessment of the pelvic floor musculature on a pelvic model.
METHODS
A randomized controlled trial of 46 participants was conducted. The participants were randomized into two groups. Both groups were taught by the same pelvic floor physiotherapist using two different teaching methods on a pelvic model. Group 1 watched an instructional video, whereas group 2 had in-person training. Both groups underwent pre- and post-training assessments consisting of a written examination and an Objective Structured Clinical Examination (OSCE). Primary outcome measure was the change in participants' pre- and post-training assessment scores. Secondary outcome measures were perceived changes in both participants' comfort level in performing pelvic floor examination and applicability of the training program to clinical practice.
RESULTS
There was no statistically significant difference between the teaching methods in the degree of improvement of the participants' mean written assessment scores (p = 0.58), OSCE scores (p = 0.15), and perceived comfort level (p = 0.19). Participants' mean pre- and post-assessment scores improved significantly (p < 0.001). Participants reported the training program to be applicable towards their clinical practice.
CONCLUSIONS
This study demonstrates that learners' assessment of pelvic floor musculature can be enhanced using varied teaching methods on a pelvic model.
Topics: Chronic Pain; Exercise Therapy; Gynecological Examination; Humans; Pelvic Floor; Pelvic Pain
PubMed: 32897461
DOI: 10.1007/s00192-020-04487-y -
The Journal of Adolescent Health :... Aug 2015The purpose of this study was to characterize the association between pelvic examination and adolescent contraceptive method use in two time periods in the 2006-2010...
PURPOSE
The purpose of this study was to characterize the association between pelvic examination and adolescent contraceptive method use in two time periods in the 2006-2010 National Survey of Family Growth (NSFG).
METHODS
Using data from the 2006-2010 NSFG, we used descriptive statistics and multivariable regression models to examine the association between pelvic examination and/or Pap smear and use of effective or highly effective contraceptive methods during two time periods (2006-2008 and 2008-2010). We used the design characteristics of the NSFG to produce population estimates.
RESULTS
More than half (57.3%) of our target population reported that they had a pelvic examination and/or Pap smear in the preceding 12 months. After considering health service use, pregnancy history, and demographic characteristics, receipt of pelvic/Pap remained significantly associated with use of effective or highly effective methods of contraception. Adjusted odds ratio = 1.86; 95% confidence interval (CI), 1.17-2.97. When we examined the relationship between pelvic/Pap and use of effective or highly effective methods within time periods, we found that the odds of effective contraception use were higher among adolescents who had received a Pap/pelvic examination in Period 1 (June 2006-May 2008) but not in Period 2 (June 2008-May 2010). Odds ratio = 3.05; 95% CI, 1.53-6.03 and odds ratio = 1.52; 95% CI, .88-2.62, Periods 1 and 2 respectively.
CONCLUSIONS
This finding provides some reassurance that although indications for pelvic examination and Pap smear among adolescents have decreased, the previously documented association between pelvic examination and effective or highly effective contraception appears to have decreased.
Topics: Adolescent; Adult; Contraception; Contraception Behavior; Early Detection of Cancer; Female; Gynecological Examination; Humans; Multivariate Analysis; Odds Ratio; Papanicolaou Test; Pregnancy; Regression Analysis; Time Factors; Uterine Cervical Neoplasms; Young Adult
PubMed: 26026477
DOI: 10.1016/j.jadohealth.2015.04.001