How Good is the Pelvic Exam

How good are pelvic examinations for finding pelvic pathology?

140 women had pelvic examinations performed by board-certified OB-GYNs, residents, and  third and fourth-year medical students while under general anesthesia. The results of the pelvic examination was compared to surgical visualization.  The sensitivity of the pelvic exam for detecting left adnexal masses was 0.23–0.36 and right adnexal masses was 0.15–0.28. Positive predictive value for left adnexal masses was 0.50–0.69 and right adnexal masses was 0.26–0.39. Differences among examiner groups were not statistically significant. Obesity, uterine size, and abdominal scars were identified as factors that decrease the accuracy of the bimanual examination.

Interexaminer reliability for pelvic examination in an emergency medicine study, including 186 patients, was poor. When one examiner had clinically significant finding on bimanual pelvic examination, a second examiner agreed only between 17 and 33 percent.

What does this mean for our practice in the emergency department. I would recommend that when the differential includes life or organ threatening pathology a radiographic study be used to assess the pelvis. Further outpatient work up or radiographic studies may be indicated (ie post menopausal bleeding).

Padilla LA, Radosevich DM, Milad MP. Accuracy of the pelvic examination in detecting adnexal masses. Obstet Gynecol. 2000 Oct;96(4):593-8.

Close RJ, Sachs CJ, Dyne PL. Reliability of bimanual pelvic examinations performed in emergency departments. West J Med. 2001 Oct;175(4):240-4