Recommendations of the Group of Experts of the Polish Society of Gynecologists and Obstetricians regarding gynecological examination and treatment of a minor person (01.01.2020).

The recommendations present the current knowledge and procedures, which can be modified and changed in some cases, after careful analysis of a given clinical situation, which in the future may become the basis for their modification and updating.

Recommendations of the Group of Experts of the Polish Society of Gynecologists and Obstetricians in the field of gynecological and obstetric care of young women with physical and intellectual disabilities.

The recommendations present the current knowledge and procedures, which can be modified and changed in some cases, after careful analysis of a given clinical situation, which in the future may become the basis for their modification and updating.

Female Child and Adolescent Sexual Abuse Cases Reported at the Geneva University Hospitals Between 2006 and 2014: A Retrospective Study.

STUDY OBJECTIVE: To provide an objective quantification of the demographic characteristics and clinical findings related to female child and adolescent sexual abuse cases reported at the Geneva University Hospitals. DESIGN: Retrospective study. SETTING: Obstetrics and gynecology emergency unit. PARTICIPANTS: Female children (0-12 years old) and adolescents (13-20 years old) seeking primary care after sexual assault. INTERVENTIONS: None, observational study. MAIN OUTCOME MEASURES: Delay from assault to time of presentation to primary care presentation, type of perpetrators, and the presence gynecological and bodily lesions. RESULTS: Compared with children, a significantly higher proportion of adolescents presented to the hospital within 24 hours (134/289 (46.4%) vs 7/33 (21.2%); P = .006). Perpetrators were family members in 15/36 (41.7%) of children and in only 14/304 (4.6%) of adolescent patients (P < .00001); perpetrators were unfamiliar/nonrelated people in 8/36 (22.2%) of children and in 166/304 (54.6%) of adolescent patients (P < .0003). We did not find a significant difference between the 2 age groups with regard to the presence of gynecological lesions (15/35 (42.9%) of children and 91/298 (30.5%) of adolescent patients). However, we found a significant difference in the proportion of patients with bodily lesions such that 11/36 (30.6%) of children and 175/300 (58.3%) of adolescents (P = .002) were afflicted with bodily lesions. CONCLUSION: To our knowledge this is the first study to evaluate child and adolescent sexual abuse cases on the basis of real-life data collected in Switzerland. Our results highlight important differences in child and adolescent sexual assault in terms of delay in presentation to primary care, perpetrator's relation to the victim, and presence of bodily lesions. This study confirms that gynecological findings alone are not consistently present in the patients who seek primary care after sexual assault.

A critical review of obstetric and gynecological physical examination videos available on YouTube: Content analysis and user engagement evaluation.

BACKGROUND: Video-sharing website "YouTube" is a growing source of healthcare information. But, the videos uploaded on this open platform are not peer reviewed, therefore, the information available needs to be sufficiently evaluated. No studies have been conducted to evaluate the authenticity and utility of obstetrics and gynecology (Obs/Gyne) physical examination YouTube videos. This study was performed to analyze the sources, contents, and quality of videos about the Obs/Gyne clinical examination available on YouTube. METHODS: A systematic search was performed on YouTube website using the following key words: "OBSTETRIC," "GYNECOLOGICAL," "SPECULUM OBSTETRIC," "OBSTETRIC CLINICAL," "BIMANUAL PELVIC," and "EXAMINATION" to analyze the sources, contents, and the quality of YouTube videos about the Obs/Gyne clinical examination during the period between November 2015 and March 2017. The videos were classified into educationally useful and useless based on the content, accuracy of the knowledge, and the demonstration. RESULTS: Out of total 457 screened videos, 176 (38.51%) videos met the pre-set inclusion criteria. After review, out of 176 pertinent videos, 84 (47.7%) videos were found educationally useful, and out of these 84 useful videos, only 29 (34.5%) were highly educational in nature. CONCLUSION: YouTube videos showed variable educational value. Only, a small number of videos were identified as useful and can be used by the medical students for self-directed learning and by the clinical teachers for educational purposes or other academic activities.

Development of a standardized, reproducible screening examination for assessment of pelvic floor myofascial pain.

BACKGROUND: Pelvic floor myofascial pain is common, but physical examination methods to assess pelvic floor muscles are defined poorly. We hypothesized that a simple, transvaginal pelvic floor examination could be developed that would be highly reproducible among providers and would adequately screen for the presence of pelvic floor myofascial pain. OBJECTIVE: The purpose of this study was to develop a simple, reproducible pelvic floor examination to screen for pelvic floor myofascial pain. STUDY DESIGN: A screening examination was developed by Female Pelvic Medicine & Reconstructive Surgery subspecialists and women's health physical therapists at our institution and tested in a simulated patient. We recruited 35 new patients who underwent examinations by blinded, paired, independent examiners. Agreement was calculated with the use of percent agreement and Spearman's rank correlation coefficient. RESULTS: The final examination protocol begins with examination of the following external sites: bilateral sacroiliac joints, medial edge of the anterior superior iliac spine, and cephalad edge of the pubic symphysis (self-reported pain: yes/no). The internal examination follows with palpation of each muscle group in the center of the muscle belly, then along the length of the muscle proceeding counter-clockwise: right obturator internus, right levator ani, left levator ani, left obturator internus (pain on a scale of 0-10). Thirty-five patients were enrolled. Correlation was high at each external (0.80-0.89) and internal point (0.63-0.87; P<.0001). CONCLUSION: Our newly developed, standardized, reproducible examination incorporates assessment of internal and external points to screen for pelvic floor myofascial pain. The examination is straightforward and reproducible and allows for easy use in clinical practice.

The use, quality and effectiveness of pelvic examination in primary care for the detection of gynaecological cancer: a systematic review.

BACKGROUND: Urgent suspected cancer referral guidelines recommend that women with gynaecological cancer symptoms should have a pelvic examination (PE) prior to referral. We do not know to what extent GPs comply, their competency at PE, or if PE shortens the diagnostic interval. OBJECTIVES: We conducted a systematic review of the use, quality and effectiveness of PE in primary care for women with suspected gynaecological cancer. METHOD: PRISMA guidelines were followed. Three databases were searched using four terms: PE, primary care, competency and gynaecological cancer. Citation lists of all identified papers were screened independently for eligibility by two reviewers. Data extraction was performed in duplicate and independently. Paper quality was assessed using the relevant Critical Appraisal Skills Programme checklist. Emergent themes and contrasting issues were explored in a narrative ecological synthesis. MAIN FINDINGS: Twenty papers met the inclusion criteria. 52% or less of women with suspicious symptoms had a PE. No papers directly explored GPs' competence at performing PE. Pre-referral PE was associated with reduced diagnostic delay and earlier stage diagnosis. Ecological synthesis demonstrated a complex interplay between patient and practitioner factors and the environment in which examination is performed. Presenting symptoms are commonly misattributed by patients and practitioners resulting in misdiagnosis and lack of PE. CONCLUSION: We do not know if pre-referral PE leads to better outcomes for patients. PE is often not performed for women with gynaecological cancer symptoms, and evidence that it may result in earlier stage of diagnosis is weak. More research is needed.

Does medical students' gender affect their clinical learning of gynaecological examination? A retrospective cohort study.

INTRODUCTION: Medical graduates should be competent in gynaecological examination as well as associated skills including speculum use and swabbing. Male and female medical students may have different opportunities to practise these skills in clinical environments, potentially impacting on confidence and competence. This study explores this further via reviewing students' learning experience in genitourinary medicine (GUM) and obstetrics and gynaecology (O&G) clinics. METHODS: Cross-sectional study of 759 year 4 and year 5 University of Birmingham medical students via an online questionnaire. This explored degree of participation, impact of gender and self-reported confidence. RESULTS: Overall response rate was 31% (233/759). Students of either gender who observed an examination being performed by a clinician were more likely to perform the same examination. Female students reported more opportunities to practise gynaecological examination and associated skills. Female students were more likely to be granted consent to perform speculum examinations, vaginal swabbing and vaginal bimanual examinations. Sixty-five per cent of male students felt that their gender affected their learning experience with female patients. Despite this, there was no significant difference in self-reported confidence level in performing gynaecological examinations between genders at the end of placement. CONCLUSION: The majority of male students perceived that their gender impacted their clinical experience in O&G and GUM. Self-reported confidence levels were unaffected, which could reflect varying approaches to competence between genders. The link between observing examinations and subsequent opportunities to practise is key. This could demonstrate students developing rapport and trust with patients, and clinicians' roles as gatekeepers.

Achieving competency in vaginal examinations: The challenge of balancing student learning needs with best practice in maternity care.

Assessment of labor progress through vaginal digital examination (VE) remains one of the most challenging skills for midwifery students. As VE during labor has become a less frequent occurrence there are less opportunities for student midwives to gain mastery of the skill. Best practices for teaching and evaluating VE involve a step-wise, multi modal approach. More research is needed on how to standardize teaching for this essential skill.

Committee Opinion No. 703 Summary: Asymptomatic Microscopic Hematuria in Women.

Asymptomatic microscopic hematuria is an important clinical sign of urinary tract malignancy. Asymptomatic microscopic hematuria has been variably defined over the years. In addition, the evidence primarily is based on data from male patients. However, whether the patient is a man or a woman influences the differential diagnosis of asymptomatic microscopic hematuria, and the risk of urinary tract malignancy (bladder, ureter, and kidney) is significantly less in women than in men. Among women, being older than 60 years, having a history of smoking, and having gross hematuria are the strongest predictors of urologic cancer. In low-risk, never-smoking women younger than 50 years without gross hematuria and with fewer than 25 red blood cells per high-power field, the risk of urinary tract malignancy is less than or equal to 0.5%. Furthermore, the evaluation may result in more harm than benefit and is unlikely to be cost effective. Thus, data support changing current hematuria recommendations in this low-risk group. The American College of Obstetricians and Gynecologists and the American Urogynecologic Society encourage organizations producing future guidelines on the evaluation of microscopic hematuria to perform sex-specific analysis of the data and produce practical sex-specific recommendations. In the meantime, the American College of Obstetricians and Gynecologists and the American Urogynecologic Society recommend that asymptomatic, low-risk, never-smoking women aged 35-50 years undergo evaluation only if they have more than 25 red blood cells per high-power field.

Effect of professional society recommendations on women's desire for a routine pelvic examination.

BACKGROUND: The American College of Physicians strongly recommends against performing pelvic examinations in asymptomatic, nonpregnant women, citing evidence of harm (false-positive testing, unnecessary surgery) and no evidence of benefit. In contrast, the American Congress of Obstetricians and Gynecologists recommends pelvic examinations in asymptomatic women beginning at age 21 years, citing expert opinion. OBJECTIVE: We sought to evaluate if providing women with professional societies' conflicting statements about pelvic examinations (recommendations and rationales) would influence their desire for a routine examination. STUDY DESIGN: We recruited 452 women ages 21-65 years from 2 women's clinics to participate in a 50-minute face-to-face interview about cervical cancer screening that included a 2-phase study related to pelvic examinations. In the first phase, 262 women were asked about their desire for the examination without being provided information about professional societies' recommendations. In the second phase, 190 women were randomized to review summaries of the American College of Physicians or American Congress of Obstetricians and Gynecologists statement followed by an interview. RESULTS: First-phase participants served as the referent: 79% (208/262) indicated they would want a routine examination if given a choice. In the second phase, a similar percentage of women randomized to the American Congress of Obstetricians and Gynecologists summary had this desire (82%: 80/97; adjusted odds ratio, 1.37; 95% confidence interval, 0.69-2.70). Women randomized to the American College of Physicians summary, however, were less likely to indicate they would opt for an examination (39%: 36/93; adjusted odds ratio, 0.12; 95% confidence interval, 0.06-0.21). Overall, 94% (179/190) believed the potential benefits and harms should be discussed prior to the examination. CONCLUSION: Providing women with a professional society's recommendation advising against routine pelvic examinations substantially reduced their desire to have one. Educational materials are needed to ensure women's informed preferences and values are reflected in decisions about pelvic examinations.

Committee Opinion No.703: Asymptomatic Microscopic Hematuria in Women.

Asymptomatic microscopic hematuria is an important clinical sign of urinary tract malignancy. Asymptomatic microscopic hematuria has been variably defined over the years. In addition, the evidence primarily is based on data from male patients. However, whether the patient is a man or a woman influences the differential diagnosis of asymptomatic microscopic hematuria, and the risk of urinary tract malignancy (bladder, ureter, and kidney) is significantly less in women than in men. Among women, being older than 60 years, having a history of smoking, and having gross hematuria are the strongest predictors of urologic cancer. In low-risk, never-smoking women younger than 50 years without gross hematuria and with fewer than 25 red blood cells per high-power field, the risk of urinary tract malignancy is less than or equal to 0.5%. Furthermore, the evaluation may result in more harm than benefit and is unlikely to be cost effective. Thus, data support changing current hematuria recommendations in this low-risk group. The American College of Obstetricians and Gynecologists and the American Urogynecologic Society encourage organizations producing future guidelines on the evaluation of microscopic hematuria to perform sex-specific analysis of the data and produce practical sex-specific recommendations. In the meantime, the American College of Obstetricians and Gynecologists and the American Urogynecologic Society recommend that asymptomatic, low-risk, never-smoking women aged 35-50 years undergo evaluation only if they have more than 25 red blood cells per high-power field.

The Annual Gynecologic Examination Updated for the 21st Century.

The concept of an annual gynecologic screening visit to identify disease at an early stage has long been an established component of women's health care. Women and their health care providers have historically accepted the schedule of an annual gynecologic examination with cervical cancer screening and a pelvic examination. Recently, researchers questioned the value of the annual breast and pelvic examinations in asymptomatic women and re-established the intervals for Pap test screening with the addition of human papillomavirus co-testing to establish cervical cancer risk. The updated well woman examination is now an opportunity to engage women in health education, screening for chronic disease risks, and health care concerns such as depression and violence.

A prospective study into the benefits of simulation training in teaching obstetric vaginal examination.

OBJECTIVE: To assess the benefits of incorporating simulations in obstetric vaginal-examination training. METHODS: A single-center, randomized, prospective study was conducted in a French University Hospital. Medical students without obstetric experience were assigned, by simple random sampling, to perform either 10 or 30 vaginal-examination training procedures using a simulator. A control group of students that had not performed any simulator training procedures was also enrolled. Medical students performed six vaginal examinations on patients who were in labor. The students reported the findings of the examinations in terms of five items (cervical length, position, consistency, dilation, and fetal presentation). The students' findings were then compared with those of experienced midwives (whose answers were considered to be the gold standard) who examined the same patients. RESULTS: A total of 66 students were included in the analyses. Students who had performed 10 simulated procedures demonstrated significantly greater accuracy in vaginal examination assessments in comparison with the control group (P<0.001). No significant difference was observed between the results for students that had performed 10 or 30 simulated procedures (P=0.44). CONCLUSION: Simulation training assisted novice students in improving their vaginal-examination skills before performing such procedures on real patients. Vaginal-examination simulations should be included in the training curriculum for students who will examine pregnant patients.

An evidence-based review of the rectovaginal examination during well-woman visits.

BACKGROUND AND PURPOSE: Women's health promotion and disease prevention has experienced considerable transformation over the past decade. This includes introduction of the Human Papillomavirus (HPV) vaccination, updated recommendations for mammography screening, Papanicolaou smear and HPV testing, and pelvic examinations. Despite significant literature about these subjects, one area that has not been reviewed is the rectovaginal examination (RVE). This article will examine available evidence regarding the RVE and make evidence-based recommendations that nurse practitioners (NPs) can integrate into practice METHODS: An electronic search was completed using PubMed, CINAHL, National Guideline Clearinghouse, and Cochrane Data Bases. Medical Subject Heading terms and keywords included Physical Examination, Vagina, Rectum, Digital Rectal Examination, Gynecological Examination, and Rectovaginal Examination in combination with Well-Woman, Screening, and Pelvic Examination. CONCLUSIONS: Available literature shows the RVE to have low sensitivity in detecting uterosacral nodularity, rectal compression, cervical involvement of endometrial cancer, and colorectal cancer. IMPLICATIONS FOR PRACTICE: This critical review of available literature found no evidence to support the use of the RVE in well-woman visits. NPs should limit the use of the RVE to patients presenting with rectovaginal or pelvic complaints.