Insights from outside BJOG

Abstract

The ‘per vaginum’ (PV) examination is central to making any gynaecological diagnoses but is it warranted in asymptomatic women? If a woman does not require cervical screening or her intra-uterine device checking, is a PV examination a legitimate part of a ‘well-woman’ visit? Harms and benefits need to be weighed about every aspect of our professional interactions and far more asymptomatic women attend clinics and doctors than those with symptoms. The potential harms of a PV examination – or to use the American term bimanual pelvic examination (BPE) – are listed as pain, discomfort, fear, anxiety and embarrassment (Bloomfield et al. Ann Intern Med 2014;161: 46–53). More importantly, the prospect of being examined vaginally may dissuade women from consulting a professional for contraceptive initiation or supplies. A survey from the USA has estimated that in 15–20-year-old women, half of all BPEs are done unnecessarily and that three-quarters of tests for cervical cancer are not in accordance with current recommendations (Qin et al. JAMA Intern Med 2020;180:274–80). Two of the most common reasons for PV examinations that could – and should – be avoided are prior to starting oral contraceptives and for cervical screening in women under the age of 25 years. Both topics are crucial to well-woman consultations but the need for a physical pelvic examination is not indicated in either set of circumstances.