Should annual pelvic exams be ultrasound assisted? (Pro & Con).

YES

The bimanual pelvic examination has not been proved to make any difference to women's health in the long run, It does not reliably detect adnexal masses. It can't evaluate ovarian function. It can't look into the endometrial cavity to explain abnormal bleeding, and for the patient it is intimidating and uncomfortable.

So why do we do it? We must have something to replace it with if we decide to save the time, effort, and inconvenience, and discomfort for the patient by not doing a bimanual pelvic exam.

A sonographic screening program increases the percent of ovarian cancers that are found at earlier stages. Granted, there are fast tumors that grow to stage III in less than 12 months. In my 18 years of experience, I have seen two that were in advanced stages after a normal ultrasound screen the year before.

The issue is day-to-day care of women who come to us hoping that we are going to detect any abnormalities in their reproductive system and prevent morbidity, inconvenience, and expensive tests.

In 352 well-woman exams in my practice in the past year, 31% of women complained of abnormal bleeding, pain, pelvic pressure, dyspareunia, or other symptoms. The ultrasound portion of the exam took usually 3 minutes, or 5 minutes at the most. We found abnormalities in 25%: in 61 symptomatic and 27 asymptomatic women.

In the symptomatic women, we found indolent pelvic inflammatory disease, polyps, adenomyosis, ovarian dysfunction or abnormal proliferation of the endometrium, diverticula of the sigmoid colon, escape-ovulation while on oral contraceptives, endometriosis, myofascial pain unrelated to the pelvic organs, and urinary retention.