The Southern Medical Journal (SMJ) is the official, peer-reviewed journal of the Southern Medical Association. It has a multidisciplinary and inter-professional focus that covers a broad range of topics relevant to physicians and other healthcare specialists.

SMJ // Article

Original Article

The Rectovaginal Examination: Physician Attitudes and Practice Patterns

Authors: Laura Davisson, MD, Karen Clark, MD, Roxann Powers, MD, Gerald Hobbs, PHD

Abstract

Background: The value of screening with the rectovaginal examination (RVE) has not been validated. This study describes physician attitudes and practice patterns regarding the RVE.


Methods: Cross-sectional survey of residents and faculty in general internal medicine and obstetrics/gynecology (OB/GYN) at a university hospital.


Results: Thirty-four percent of physicians surveyed reported routinely performing the RVE. More OB/GYN than internal medicine physicians reported doing the RVE routinely (60% versus 27%, P = 0.02), and felt it provided additional information (80% versus 44%, P = 0.01). More respondents believed that it provides additional information to the routine pelvic examination (53%) than agreed with its routine inclusion (42%) or that reported routinely performing it (34%). (P = 0.0001)


Conclusions: More OB/GYN than internal medicine physicians routinely perform the RVE and believe it adds additional information to the routine pelvic examination. Additional research is indicated to determine if frequent omission of the RVE impacts women’s health.


Key points:


* This study revealed a lack of uniformity in practice patterns regarding the RVE.


* Only 34% of all physicians surveyed routinely perform a RVE and it is done more frequently by OB-GYN physicians than internists.


* Research is needed to explore patient attitudes, as well as the diagnostic necessity of the RVE, in order to determine its value in routine pelvic examination screening.


* Researching the value of the RVE will help determine whether the more frequent failure to perform the RVE by internists as compared to OB/GYN physicians represents a need for improved training in internal medicine programs.


* If evidence continues to mount that suggests a lack of efficacy of the RVE, particularly if data confirms that the RVE causes discomfort, it is possible that the performance of this examination can be abandoned as part of the routine pelvic exam.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Swartz MH. Textbook of Physical Diagnosis: History and Physical Examination. Second Edition. Philadelphia, WB Saunders, 1994, pp 375–391.
 
2. Stenchever MA, Droegemueller W, Herbst AL, Mishell DR. Comprehensive Gynecology. 4th ed. St Louis, Mosby, 2001, pp 150–151.
 
3. US Preventive Services Task Force. Guide to Clinical Preventive Services. 2nd ed. Baltimore, Williams & Wilkins, 1996, pp lvii–lxix.
 
4. Oboler SK, LaForce FM. The periodic physical examination in asymptomatic adults. Ann Intern Med1989;110:214–226.
 
5. Dragisic KG, Padilla LA, Milad MP. The accuracy of the rectovaginal examination in detecting cul-de-sac disease in patients under general anaesthesia. Hum Reprod 2003;18:1712–1715.
 
6. Grover SR, Quinn MA. Is there any value in bimanual pelvic examination as a screening test? Med J Aust 1995;162:408–10.
 
7. Willis FL, Fanning J. Digital rectal fecal occult blood screening during gynecologic examination. Am J Obstet Gynecol 2004;190:1422–1423.
 
8. Campbell KA, Shaughnessy AF. Diagnostic utility of the digital rectal examination as part of the routine pelvic examination. J Fam Pract 1998;46:165–167.
 
9. Pignone M, Rich M, Teutsch SM, et al. Screening for colorectal cancer in adults at average risk: a summary of the evidence for the US Preventive Services Task Force. Ann Intern Med 2002;137:132–141.
 
10. Vondruska-Benkert K, Steiner RA, Buddeberg G, Haller U. Gynecologic examination: perceptions, fears and expectations of polyclinic patients [in German]. Gynakol Geburtshilfliche Rundsch1995;35:20–25.
 
11. Vella PV. A survey of women undergoing a pelvic examination. Aust N Z J Obstet Gynaecol1991;31:355–357.
 
12. Dixon JG, Bognar BA, Keyserling TC, et al. Teaching women’s health skills: confidence, attitudes, and practice patterns of academic generalist physicians. J Gen Intern Med 2003;18:411–418.
 
13. Cassel C, Blank L, Braunstein G, et al. What internists need to know: core competencies in women’s health: ABIM Subcommittee on Clinical Competence in Women’s Health. Am J Med1997;102:507–12.