I have a quandary. Now a days, if a woman is monogamous and has had 3 normal PAPs and no hx of abnormal PAPs and you might even do an HPV and if negative can be more confident that you only need to do PAPs q 3 years.
My question is, is there any reason to be doing pelvic exams (in asymptomatic women) in between those 3 year periods, or really, at all?
I can’t find any official recommendations on pelvic exams. Most patients are obese and you can’t feel anything anyway, so I am really beginning to wonder why we bother doing them at all but the question is, are we supposed to do them every year even though not doing PAPs every year.Thoughts?
Kathy Saradarian, MD
Branchville, NJ www.qualityfamilypractice.com
Solo 4/03, Practicing since 9/90; Practice Partner 5/03
This quandary has been mostly resolved among family physicians in the Medicos project 1999-2009. Steve Goldstein MD ACOG has previously published his strong opinions regarding the poor sensitivity and specificity of the pelvic examination. I agree that we should be teaching pelvic ultrasound to every physician who would care for women.
Pelvic pain women are diagnostic orphans in the current system of generic primary care. I find no physicians who have received accountable training in the bimanual pelvic examination. Residency trained physicians cannnot detect the common causes of pevic pain--PID with TOA, PID with free fluid, PID with pyosalpinx, Missed Ab, degenerated fibroids, ovarian cysts, Polycystic Ovarian Syndrome, probable ovarian Ca.
.
These are examples of cases diagnosed in our family medicine office this month. By keeping the faith with OB ultrasound in the FP office, we have gone on to offer point of service immediate ultrasound for our patients. Worse yet these women frequently need another appointment, another care trip, another stranger who is not a physician, another inconvenience to obtain the most sensitve and specific examination available. Ultrasound.
No radiation and unrestricted physicians can do it in their office at the time of service.
It's natural win-win. Where is the advocacy on this issue?
Pelvic exams are only useful for visual inspections and acquistion of secretions/ biopsies.Paps, HPV, discharges, colposcopy, and surface anatomy problems.
Note the silent disappearance of the rectovaginal exam after years of "insisting" that it was useful. Medicos will try to organize a "teach the teachers" conference for Gyn ultrasound as we did in 1992 when we were at at UT in Memphis. Any interested collaborators?
With best wishes for your professional success,
Wm. MacMillan Rodney MD, FAAFP, FACEP
American Board of Family Medicine Obstetrics
Medicos para la Familia
Memphis, Nashville, rural, and international
www.psot.com
Practice Partner EMR since 1999
For what it’s worth, here’s what just came out of ACOG.
John L. Pfenninger, MD
Hi…let me know when this class is….I am comfortable with basic L and D U/S…..I need GYN and dating U/S skills…..JMS
Juliemarie M Sicilia MD
Associate Director Alaska WWAMI
Alaska Family Medicine Residency
Index--pelvic exam, gyn ultrasound
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