Routine pelvic examinations: A descriptive cross-sectional survey of women's attitudes and beliefs after new guidelines

Kling, Juliana M.; Vegunta, Suneela; Al-Badri, Mina; Faubion, Stephanie S.; Fields, Heather; Shah, Amit; Wallace, Mark R.; Ruddy, Barbara E.; Bryan, Michael; Temkit, Mʼhamed; MacLaughlin, Kathy L.

doi:10.1016/j.ypmed.2016.11.007

Cited by 10 publications

(5 citation statements)

References 25 publications

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“…39 Studies examining women's attitudes and beliefs regarding routine pelvic examination showed that one-half of the women 21 years or older did not know the purpose of the pelvic examination, and yet most women believed that routine pelvic examinations were necessary for STI screening, contraception initiation, and cancer detection and have value in reassuring the patient that she is in good health, particularly among older women. 40,41 After education on the American College of Physicians' recommendation advising against routine pelvic examinations, substantially fewer women wanted to have one. 40,42 When asked about how often they think they will need to have a pelvic examination or a Pap test in the 2011-2017 NSFG, more than 71% of young women aged 15 to 20 years thought they need to have a BPE or a Pap test at least once every 2 years, contrary to guideline recommendations.…”

Section: Discussionmentioning

confidence: 99%

“…40,41 After education on the American College of Physicians' recommendation advising against routine pelvic examinations, substantially fewer women wanted to have one. 40,42 When asked about how often they think they will need to have a pelvic examination or a Pap test in the 2011-2017 NSFG, more than 71% of young women aged 15 to 20 years thought they need to have a BPE or a Pap test at least once every 2 years, contrary to guideline recommendations.…”

Section: Discussionmentioning

confidence: 99%

“…Studies examining women’s attitudes and beliefs regarding routine pelvic examination showed that one-half of the women 21 years or older did not know the purpose of the pelvic examination, and yet most women believed that routine pelvic examinations were necessary for STI screening, contraception initiation, and cancer detection and have value in reassuring the patient that she is in good health, particularly among older women . After education on the American College of Physicians’ recommendation advising against routine pelvic examinations, substantially fewer women wanted to have one .…”

Section: Discussionmentioning

confidence: 99%

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Prevalence of Potentially Unnecessary Bimanual Pelvic Examinations and Papanicolaou Tests Among Adolescent Girls and Young Women Aged 15-20 Years in the United States

et al. 2020

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IMPORTANCE Pelvic examination is no longer recommended for asymptomatic, nonpregnant women and may cause harms such as false-positive test results, overdiagnosis, anxiety, and unnecessary costs. The bimanual pelvic examination (BPE) is an invasive and controversial examination component. Cervical cancer screening is not recommended for women younger than 21 years. OBJECTIVESTo estimate prevalence of potentially unnecessary BPE and Papanicolaou (Pap) tests performed among adolescent girls and women younger than 21 years (hereinafter referred to as young women) in the United States and to identify factors associated with receiving these examinations. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional analysis of the National Survey of Family Growth from September 2011 through September 2017 focused on a population-based sample of young women aged 15 to 20 years (n = 3410). The analysis used survey weights to estimate prevalence and the number of people represented in the US population. Data were analyzed from December 21, 2018, through September 3, 2019. MAIN OUTCOMES AND MEASURES Receipt of a BPE or a Pap test in the last 12 months and the proportion of potentially unnecessary examinations and tests. RESULTSResponses from 3410 young women aged 15 to 20 years were included in the analysis with 6-year sampling weights applied. Among US young women aged 15 to 20 years represented during the 2011-2017 study period, 4.8% (95% CI, 3.9%-5.9%) were pregnant, 22.3% (95% CI, 20.1%-24.6%) had undergone STI testing, and 4.5% (95% CI, 3.6%-5.5%) received treatment or medication for an STI in the past 12 months (Table 1). Only 2.0% (95% CI, 1.4%-2.9%) reported using an IUD, and 33.5% (95% CI, 30.8%-36.4%) used at least 1 other type of hormonal contraception in the past 12 months. Among US young women aged 15 to 20 years who were surveyed in the years 2011 through 2017, approximately 2.6 million (22.9%; 95% CI, 20.7%-25.3%) reported having received a BPE in the last 12 months. Approximately half of these examinations (54.4%; 95% CI, 48.8%-59.9%) were potentially unnecessary, representing an estimated 1.4 million individuals. Receipt of a BPE was associated with having a Pap test (adjusted prevalence ratio [aPR], 7.12; 95% CI, 5.56-9.12), testing for sexually transmitted infections (aPR, 1.60; 95% CI, 1.34-1.90), and using hormonal contraception other than an intrauterine device (aPR, 1.31; 95% CI, 1.11-1.54). In addition, an estimated 2.2 million young women (19.2%; 95% CI, 17.2%-21.4%) reported having received a Pap test in the past 12 months, and 71.9% (95% CI, 66.0%-77.1%) of these tests were potentially unnecessary.CONCLUSIONS AND RELEVANCE This analysis found that more than half of BPEs and almost three-quarters of Pap tests performed among young women aged 15 to 20 years during the years 2011 through 2017 were potentially unnecessary, exposing women to preventable harms. The results suggest that compliance with the current professional guidelines regarding the appropriate use of these examinations and tests may be lacking.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Prevalence of Potentially Unnecessary Bimanual Pelvic Examinations and Papanicolaou Tests Among Adolescent Girls and Young Women Aged 15-20 Years in the United States

et al. 2020

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“…Beyond these embodied reactions, many patients also reported that they do not understand the purpose of the PE and/or of cervical cancer screenings (Bush, 2000;Norrell et al, 2017;Williams and Williams, 2013). Research findings have shown that a majority believe routine PEs are necessary before receiving prescriptions for contraception (Kling et al, 2017). A UK study that interviewed 35 women on their experiences with routine PEs and cervical cancer screenings 1 provided some alarming conclusions that suggested medical coercion; not only did they think the PE was required for renewal of contraception prescriptions but participants also reported that clinicians did not present the exam as optional (Bush, 2000).…”

Section: Contemporary Review a Patients' Experiences Of The Pementioning

confidence: 99%

‘Poorly relaxed women’: A situational analysis of pelvic examination learning materials for medical students

Towle

2022

Medical Education

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I. Historical Review………………………………………………………. p. a. The invention of the speculum: Lucy, Anarcha, and Betsey…… p. b. Sex workers, 'models,' and marginalized groups………………. p. c. The introduction of the anesthetized PE………………………... p. d. 'Our bodies, ourselves:' Gynaecological teaching associates…... p. II. Contemporary Review…………………………………………………. p. a. Patients' experiences of the PE…………………………………. p. b. Medical student perspectives on the PE……………………….... p. c. Medical school culture and #MeTooPelvic……………………... p. d. Medical education curricula…………………………………….. p. e. Screening guidelines and DIY cervical swabs………………….. p. f. Patient-centred improvements…………………………………... p.

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“…The gynaecological examination (GE) is a procedure that women may experience as embarrassing, painful and even threatening, and there is limited guidance on decision making, and technical as well as interpersonal aspects of the GE [1]. While many women have a positive attitude to the medical benefits of GEs [2], they sometimes have adverse expectations when preparing for the procedure, and may experience the procedure negatively [3]. This calls for interpersonal sensitivity and rigorous professional judgement on the doctor’s side in determining when and how to perform a GE.…”

Section: Introductionmentioning

confidence: 99%

The when and how of the gynaecological examination: a survey among Norwegian general practitioners

Hjörleifsson

Bjorvatn

Meland

et al. 2019

Scandinavian Journal of Primary Health Care

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Introduction: Little is known about the indications general practitioners (GPs) perceive as relevant for performing gynaecological examinations (GEs), how GPs master the GE and associated procedures, and how they handle the sensitive nature of GEs. Methods: In 2015, 70 medical students at the University of Bergen distributed a questionnaire to all 175 GPs in the practices they visited. The questions covered practical routines related to GEs, insertion of intrauterine device, frequency of GEs in different clinical settings and use of assisting personnel. Statistical analyses included chi-square tests and multiple logistic regressions adjusting for age, gender, specialization and localization. Results: Ninety male and 61 female GPs (87% of invited GPs) responded to the questionnaire. A minority (8%) usually had other staff present during GEs. Compared with female colleagues, male GPs performed bimanual palpation significantly less often in connection with routine Pap smear (AOR 0.3 (95% CI 0.1-0.6)). Twenty-eight percent of the GPs stated that they often/always omitted the GE if the patient was anxious about GE and 35% when the patient asked for referral to a gynaecologist. Omission was more frequent among male GPs. When the GP decided to refer to a gynaecologist based on the patient’s symptoms, more male than female GPs omitted GE (AOR 2.5 (95% CI 1.1-5.4)). Conclusion: Male gender of the GP may be associated with barriers to medical evaluation of pelvic symptoms in women, potentially leading to substandard care. Possibly, however, male GPs’ reluctance to perform the GE may also limit unnecessary bimanual palpation in asymptomatic women.

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Routine pelvic examinations: A descriptive cross-sectional survey of women's attitudes and beliefs after new guidelines

Cited by 10 publications

References 25 publications

Prevalence of Potentially Unnecessary Bimanual Pelvic Examinations and Papanicolaou Tests Among Adolescent Girls and Young Women Aged 15-20 Years in the United States

Prevalence of Potentially Unnecessary Bimanual Pelvic Examinations and Papanicolaou Tests Among Adolescent Girls and Young Women Aged 15-20 Years in the United States

‘Poorly relaxed women’: A situational analysis of pelvic examination learning materials for medical students

The when and how of the gynaecological examination: a survey among Norwegian general practitioners

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