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New consensus guidelines from a multispecialty working group of the Pelvic Floor Disorders Consortium (PFDC) clear up inconsistencies in the use of magnetic resonance defecography (MRD) and provide universal recommendations [...]

Pregnancy-related back pain and pelvic girdle pain (PGP) are common across countries, irrespective of socioeconomic factors. (1) In general, the literature does not make a clear distinction between pregnancy-related low [...], Background. No appropriate measures have been specifically developed for pelvic girdle pain (PGP). There is a need for suitable outcome measures that are reliable and valid for people with PGP for use in research and clinical practice. Objective. The objective of this study was to develop a condition-specific measure, the Pelvic Girdle Questionnaire (PGQ), for use during pregnancy and postpartum. Design. This was a methodology study. Methods. Items were developed from a literature review and information from a focus group of people who consulted physical therapists for PGP. Face validity and content validity were assessed by classifying the items according to the World Health Organization's International Classification of Functioning, Disability and Health. After a pilot study, the PGQ was administered to participants with clinically verified PGP by means of a postal questionnaire in 2 surveys. The first survey included 94 participants (52 pregnant), and the second survey included 87 participants (43 pregnant). Rasch analysis was used for item reduction, and the PGQ was assessed for unidimensionality, item fit, redundancy, and differential item functioning. Test-retest reliability was assessed with a random sample of 42 participants. Results. The analysis resulted in a questionnaire consisting of 20 activity items and 5 symptom items on a 4-point response scale. The items in both subscales showed a good fit to the Rasch model, with acceptable internal consistency, satisfactory fit residuals, and no disordered threshold. Test-retest reliability showed high intraclass correlation coefficient estimates: .93 (95% confidence interval=0.86-0.96) for the PGQ activity subscale and .91 (95% confidence interval=0.84-0.95) for the PGQ symptom subscale. Limitations. The PGQ should be compared with low back pain questionnaires as part of a concurrent evaluation of measurement properties, including validity and responsiveness to change. Conclusions. The PGQ is the first condition-specific measure developed for people with PGP. The PGQ had acceptably high reliability and validity in people with PGP both during pregnancy and postpartum, it is simple to administer, and it is feasible for use in clinical practice.

Background: Nucleic acid amplification tests (NAATs) allow chlamydia screening in asymptomatic women who otherwise may not have pelvic examinations. How often these women have examination findings that may prompt empiric therapy is unclear. Objective: The objective of this study was to assess the relationship of chlamydia with pelvic examination findings in asymptomatic women screened by NAAT. Methods: The authors conducted a retrospective analysis of clinical data from 577 young asymptomatic women screened by chlamydial transcription-mediated amplification (TMA). Results: TMA was positive in 68 (11.8%). The most common examination finding was vaginal discharge (5.9%) followed by cervical ectopy (3.6%), endocervical mucopus (2.3%) or easily induced bleeding (2.3%), and cervical motion (1.4%) or adnexal (0.7%) tenderness. On multivariate analysis, only easily induced bleeding or mucopus predicted chlamydia (adjusted odds ratio [AOR] = 4.7; P = 0.010 and AOR = 4.4; P = 0.015, respectively). Conclusions: Abnormal pelvic examination findings were infrequent in asymptomatic young women screened by a chlamydial NAAT. However, endocervical bleeding or mucopus, when present, predicted chlamydia.

In September 2010, The Society of Obstetricians and Gynaecologists of Canada (SOGC) and The Association of Professors of Obstetrics and Gynaecology of Canada (APOG) issued an updated policy statement on [...]

The annual pelvic examination has been in the spotlight lately. After a commentary questioning its value was published early this year in the Journal of Women's Health, the Wall Street [...]

Decisions regarding treatment options for patients with rectal cancer are based on the stage of the disease. Accurate preoperative staging is important in rectal cancer because small tumors may require only local excision and preoperative radiotherapy may be indicated. The most commonly used method for determining the extent of cancer penetration of the wall of the rectum and the status of the local lymph nodes is manual examination of the rectum by the physician (digital examination). In evaluating small lesions, this method has an accuracy rate of between 60 and 70 percent. Intrarectal ultrasound (IRUS) has been used to evaluate prostate disease, and has been adapted for staging of rectal cancer. A study was undertaken to assess the accuracy of IRUS in rectal cancer staging, as well as in a group of patients with uncertain pelvic or rectal disease. There were 52 cancer patients prospectively studied; they were evaluated and staged using both digital exam and IRUS. These results were compared with pathologic examination of the removed rectal tissue. The accuracy of the digital exam in determining rectal wall penetration was 48 percent, and was 83 percent for IRUS. There were 24 patients evaluated with uncertain pelvic or rectal disease. IRUS diagnosis correctly corresponded with the pathological diagnosis in 15 of 17 cases in which a tissue sample was taken. IRUS provided new information on 6 of the 24 patients. These data suggest that intrarectal ultrasound is accurate in staging rectal cancer and may be helpful in diagnosing pelvic and rectal disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

About the New Pelvic Exam Guidelines What new guidelines? The American College of Physicians no longer recommends annual pelvic exams--when your doc manually checks you inside and out--unless you are [...]

The digital rectal examination (DRE) is an uncomfortable procedure that adds time to the routine pelvic examination. Patients may postpone or defer their pelvic examination because of this discomfort. Although [...]

'The purpose of this article is to compare 3D T2-weighted sampling perfection with application-optimized contrast with different flip-angle evolutions (SPACE) with three-plane 2D turbo-spin echo (TSE) sequences for female pelvic [...]

For women with a history of sexual abuse, a pelvic examination can be stressful or traumatic. In addition to all accepted relaxation and reassurance techniques, the elevation of the head [...]

2003 APR 3 - (NewsRx.com & NewsRx.net) -- Some of the nation's leading medical schools have abandoned a little-known, decades-old practice of letting students perform pelvic exams on women without [...]

2003 MAR 20 - (NewsRx.com & NewsRx.net) -- Medical students commonly perform pelvic examinations in the operating room when the patient is under anesthesia. This educational practice poses no physical [...]

The bimanual pelvic examination is considered an important element in the evaluation of pelvic and abdominal complaints in women, including emergency conditions such as ectopic pregnancy, pelvic inflammatory disease, and [...], * Objective To test the reliability of bimanual pelvic examinations performed in emergency departments by emergency medicine physicians. * Design Prospective observational study; 2 examiners each recorded various pelvic examination findings on 186 patients. * Setting A private university hospital and a public county hospital staffed by attending emergency medicine physicians who share an emergency medicine residency program. * Subjects Senior resident (3rd or 4th year) and attending emergency physicians. * Main outcome measures Percentage of agreement and percentage of positive agreement for cervical motion tenderness, uterine tenderness, adnexal tenderness, adnexal mass, and uterine size (within 2 cm). * Results The agreement ranged between 71% and 84%, but the percentage of positive agreement was much lower, ranging from 17% to 33%. Agreement for uterine size, within 2 cm, was 60%. * Conclusion The findings of bimanual pelvic examinations performed by emergency physicians in an emergency department have poor interexaminer reliability.

PRACTICE CHANGER Put lubricating gel, not water, on the speculum every time you do a pelvic exam. (1) STRENGTH OF RECOMMENDATION B: Based on one good-quality, randomized controlled trial. Hill [...]

'IS THE ANNUAL PELVIC EXAM A RELIC OR A REQUISITE?' BARBARA S. LEVY, MD (APRIL 2011) The stethoscope was invented in 1816 by a French physician, Rene-Theophile-Hyacinthe Laennec. By amplifying [...]

The new pelvic exam guidelines from the American College of Physicians may be a relief for women who would prefer to forgo the annual ritual, but they could also lead [...]

Q Wait, why did my doctor put her finger up my butt? I thought it was a pelvic exam! A She's probably trying to evaluate the backside of your pelvis, [...]

FROM OBSTETRICS & GYNECOLOGY Guidelines concerning the important elements of annual well-woman visits, such as when to perform pelvic exams in asymptomatic patients and when to begin formal breast exams, [...]

When young girls present for their first pelvic exam, it may help to ask if they have ever had a throat culture. If they have, explain that the vaginal canal [...]

Q. We're seeing more and more patients who are obese. Because of their habitus, we are unable to evaluate the uterus and ovaries adequately at the time of the well-woman […]

Physicians should perform routine screening of all sexually active women at increased risk for gonorrhea, because of the high risk for pelvic inflammatory disease, ectopic pregnancy, and chronic pelvic pain [...]

Q I have a friend in her late 20s who has never been to a gynecologist. She thinks because she's not sexually active, she doesn't need to go. How can [...]

YES We can make very rapid diagnoses by looking at women year after year with ultrasound. A sonographic screening program increases the percent of ovarian cancers that are found at [...]

Without obtaining explicit consent, medical students have been routinely performing pelvic exams on unconscious women, the Wall Street Journal reported, citing three recent studies published in medical journals. One study [...]

'Some of the nation's leading medical schools have abandoned a little known, decades-old practice of letting students perform pelvic exams on women without their consent while they are under anesthesia. [...]

BIG SKY, MONT. -- The gynecologic care of young girls and adolescents requires a different approach than used for adults, Dr. Joseph S. Sanfilippo said at an ob.gyn. update sponsored [...]

KAUAI, HAWAII -- The best tool for detecting ovarian cancer is your suspicion. Family history CA 125 testing, and ultrasound are ineffective or impractical for screening the general population. Your [...]

Campbell KA, Shaughnessy AF. Diagnostic utility of the digital rectal examination as part of the routine pelvic examination. J Fam Pract 1998; 46:165-7. Clinical question What is the diagnostic yield [...]