Clinician perspectives on bimanual pelvic examinations for asymptomatic women across the lifespan

Background. Recent changes to cervical cancer screening recommendations call for less-than-annual testing, prompting questions about the independent value of routine bimanual pelvic examinations. Objective. We investigated clinicians' practices and perspectives on routine bimanual pelvic examinations. Research Design & Subjects. A nationally-representative, mailed survey of currently practicing gynecologists and obstetrician/gynecologists was conducted (n = 521, response rate 62%). Measures. Four patient-vignettes were presented, describing asymptomatic women aged 18, 35, 55, and 70 years, for whom cervical cancer screening is not recommended. Clinicians were asked about their practices and the importance of different reasons for conducting routine bimanual pelvic examinations. Results. Nearly all respondents indicated that bimanual pelvic examinations were appropriate for asymptomatic women in a variety of clinical scenarios across the lifespan, including more than half considering it very important in a woman with no uterus or ovaries. Reasons deemed very important by a high proportion were detection of ovarian cancer (47%), identification of benign uterine (59%) and ovarian (54%) conditions, and reassurance of patient health (49%). Providers in group practices and those from the West were less likely to consider the examination very important. Conclusions. Bimanual pelvic examinations are provided to healthy women across the lifespan in visits where cervical cancer screening is not recommended. The most frequently cited reasons include screening for ovarian cancer despite evidence against its use for this purpose, and for benign conditions. Clinical evidence and patient perspectives are needed to clarify benefits of the examination relative to other preventive services in annual well-woman visits.