Pelvic examination of asymptomatic women: attitudes and clinical practice

Background: Many women see their general practitioner for 'well woman' checks, which often include Pap tests and a pelvic examination. A recent review of the evidence revealed pelvic examination in asymptomatic women is not a valid screening test, particularly with regard to ovarian cancer screening. Method: This project explored the attitudes of GPs regarding the performance of pelvic examinations in asymptomatic women. Twenty-seven GPs were interviewed about their current practice and opinions of the value, advantages and disadvantages of pelvic examinations in asymptomatic women. The interview data was analysed qualitatively. Discussion: The majority of the GPs interviewed perform pelvic examinations as part of a well woman check. Despite broad consensus by the GPs that the value of a pelvic examination as a screening test was questionable, they were performed for a range of reasons including patient reassurance, documenting the norm, 'because I was taught to', for legal reasons, and for completeness. The disadvantages of performing pelvic examinations in asymptomatic women noted by the GPs were time constraints, chaperone issues, intimacy concerns, and false reassurance and unnecessary anxiety caused by unexpected findings. However, neither these disadvantages nor the presentation of evidence based guidelines dissuaded the doctors from performing the examinations. This highlights the ongoing discrepancy between the theoretical development of such recommendations and their practical implementation