2948 Prospective, Single-Blinded Pilot Study: Bimanual Pelvic Examination Versus Pelvic Ultrasound Results in Symptomatic Women

Abstract

Study Objective To compare the results of bimanual pelvic exam (BPE) to Pelvic Ultrasound (PU) in symptomatic women. The American College of Physicians reported that 35% of women may experience pain, discomfort, embarrassment, or anxiety during a pelvic exam. This may serve as a barrier for women to seek medical care, which could potentially delay diagnosis. While prior studies show lack of evidence for routine BPE in asymptomatic women, its use in symptomatic women may also be limited. Design Prospective single-blinded pilot study. Setting Free-standing ambulatory surgery center serving the Washington, DC area. Patients or Participants Women, 18 years or older, with BMI < 40, presenting for evaluation of symptomatic gynecologic problems. Interventions BPE was performed by an experienced gynecologist blinded to the patient's previous ultrasound results. The sonographer was also blinded to BPE results. Measurements and Main Results A total of 20 patients were evaluated, 45% for abnormal uterine bleeding, 60% for pelvic pain or dysmenorrhea, 25% for infertility or pregnancy losses, and 15% for post-menopausal bleeding. While PU indicated adnexal abnormalities in 25% of patients (hydrosalpinx, ovarian cysts or endometrioma), BPE only identified 1 case, for a detection rate of 20%. PU identified myomas in 80% of the cases, while BPE detected only 5 cases, for a detection rate of 31%. Although the size and location of myomas were mostly undetermined by BPE, it did accurately assess uterine size in 80% of the cases. Conclusion BPE offers little clinical utility in diagnosing gynecologic problems in symptomatic women. A full prospective study of a large number of patients is in progress to further validate these results. To compare the results of bimanual pelvic exam (BPE) to Pelvic Ultrasound (PU) in symptomatic women. The American College of Physicians reported that 35% of women may experience pain, discomfort, embarrassment, or anxiety during a pelvic exam. This may serve as a barrier for women to seek medical care, which could potentially delay diagnosis. While prior studies show lack of evidence for routine BPE in asymptomatic women, its use in symptomatic women may also be limited. Prospective single-blinded pilot study. Free-standing ambulatory surgery center serving the Washington, DC area. Women, 18 years or older, with BMI < 40, presenting for evaluation of symptomatic gynecologic problems. BPE was performed by an experienced gynecologist blinded to the patient's previous ultrasound results. The sonographer was also blinded to BPE results. A total of 20 patients were evaluated, 45% for abnormal uterine bleeding, 60% for pelvic pain or dysmenorrhea, 25% for infertility or pregnancy losses, and 15% for post-menopausal bleeding. While PU indicated adnexal abnormalities in 25% of patients (hydrosalpinx, ovarian cysts or endometrioma), BPE only identified 1 case, for a detection rate of 20%. PU identified myomas in 80% of the cases, while BPE detected only 5 cases, for a detection rate of 31%. Although the size and location of myomas were mostly undetermined by BPE, it did accurately assess uterine size in 80% of the cases. BPE offers little clinical utility in diagnosing gynecologic problems in symptomatic women. A full prospective study of a large number of patients is in progress to further validate these results.