Purpose: To determine if urinary symptoms are more common in women during the 4 weeks after a routine pelvic examination.Methods: This was a 4-week, prospective, observational cohort study in a Family Medicine residency clinic at an urban university. Participants included women ages 18 to 40 years who identified themselves as sexually active and who presented for a routine pelvic examination. Controls were women presenting for other health maintenance with no pelvic examination. Independent variables included age, pelvic examination/no pelvic examination, intercourse frequency, and condom use. Dependent variables included dysuria and urinary frequency. Relative rates of dysuria and frequency were compared using 2 analysis. Mean rates of dysuria, frequency, intercourse, and condom use were compared using 2-tailed t tests.Results: Sixty-three subjects and 87 controls completed the study. More subjects had days with dysuria (17% vs 7%; P < .01), days with frequency (27% vs 14%; P < .01), days with both dysuria and frequency (13% vs 3%; P < .01), and days with either dysuria or frequency (32% vs 17%; P < .01). Subjects had less intercourse than controls (1.6 times per week vs 2.2 times per week; P < .01) and used condoms less frequently (33% vs 41%; P < .01).Conclusions: Dysuria and urinary frequency are more common among sexually active women during the month after a routine pelvic examination. (J Am Board Fam Med 2011;24:290 -295.)

Purpose: To determine if genitourinary problems are more common in women in the first 1 to 2 months after a routine pelvic examination.Methods: This was a historical cohort study in 2 family medicine teaching clinics at an urban university. Participants included all women who received a Papanicolaou smear during calendar year 2006. Subjects included all participants for weeks 1 to 7 after their Papanicolaou smear. Controls were all participants in weeks 8 to 52 after their Papanicolaou smear. The independent variable was time after Papanicolaou smear, and dependent variables included frequency of visits for urinary complaints, diagnosed urinary tract infections (UTIs), vaginal complaints, diagnosed vaginitis, and sexually transmitted diseases. Relative frequencies compared using 2-tailed t tests.Results: UTIs and urinary complaints were significantly more frequent during the first 7 weeks after a Papanicolaou smear compared with weeks 8 to 14, 8 to 48, and 8 to 52. The overall rate of UTIs was 7.33 per 100 person-years; the attributable risk during the first 7 weeks was 0.82 per 100 personyears, or 11% of observed UTIs. Combined Candidal and bacterial vaginitis was marginally more frequent during the first 7 weeks compared with weeks 8 to 48 and 8 to 52 only. The incidence of sexually transmitted diseases combined was 1.13 per 100 person-years, distributed evenly over the study period unrelated to time. Urinary tract infections (UTIs) are very common among adult women, accounting for more than 6 million physician office visits yearly in the United States. Sexual intercourse has long been recognized as one of the primary risk factors for female UTIs. 1Proposed mechanisms for this increased risk include propulsion of bacteria up the urethra into the bladder; microtrauma to the urethra and bladder mucosa, allowing bacterial adhesion; and alteration of normal flora. We postulated that the pelvic examination, including speculum insertion and bimanual examination, may increase the risk of UTIs by similar mechanisms. A small, retrospective, casecontrol study suggested such an association.2 A recent study has also demonstrated that symptoms of UTIs, namely dysuria and frequency, are more common in sexually active women in the 4 weeks after a screening pelvic examination.3 This study examined a larger cohort of women after a routine pelvic examination for the timing and frequency of genitourinary problems. MethodsThis was a historical cohort study performed by chart review. Participants were all women who had a Papanicolaou test at either of our 2 clinics during the calendar year 2006. Participants were identified through billing records, and a total of 1582 women were included. Participants were excluded only if they had no follow-up visit at our medical center since the initial Papanicolaou smear. The 2 clinics are university-based family medicine clinics in an urban setting, serving a diverse, large-city popula-

Medication abortion services in a student health care clinic are safe and feasible. However, additional treatment may be required with some patients.