Correspondence

Routine Pelvic Examinations in Asymptomatic Young Women

N Engl J Med 1996; 335:1847-1848December 12, 1996

Article

To the Editor:

A first-catch urine sample from women may be an appropriate specimen for diagnosing chlamydial and gonococcal infection by DNA-amplification procedures.1,2 This noninvasive means of obtaining a diagnostic specimen may provide a way to reach sexually active women who should be screened for sexually transmitted diseases but who lack adequate access to health care or fear pelvic examinations. One concern about substituting the examination of first-catch urine specimens for pelvic examinations is that clinical information may be lost. To determine the treatable conditions that were detected during routine pelvic examinations, we reviewed the charts of all girls and young women (13 to 20 years of age) who had routine pelvic examinations at a health maintenance organization and a university-based clinic for teenagers. During a one-year period 564 girls and young women had pelvic examinations, and 330 (mean age, 16.4 years) met our criteria: they were sexually active, were asymptomatic (symptoms were not the reason for the visit), and had tests for chlamydiae and gonococci. Most of the pelvic examinations (51 percent) were routine, 15 percent were done to rule out sexually transmitted diseases, 13 percent to rule out pregnancy, and 21 percent to establish a means of contraception. According to their histories, 78 percent of the subjects had had no recent genital symptoms, whereas 15 percent had had vaginal discharge, itching, or abnormal bleeding. On examination, 92 percent of the subjects had no abnormal signs; the most common finding (6 percent) was vaginal discharge. A total of 6.2 percent had chlamydial infection, and 0.6 percent had gonorrhea on the basis of culture, enzyme immunoassay, or both. Wet mounts were positive for infection in about 12 percent (5 percent had a yeast infection, 6 percent bacterial vaginosis, and 2 percent trichomoniasis). Nine percent of the subjects were pregnant, and 1.4 percent had an abnormal Papanicolaou smear (all had cervical intraepithelial neoplasia grade 1 or low-grade squamous intraepithelial lesions).

Conditions requiring intervention in this asymptomatic group were for the most part trivial or diagnosable with examination of urine specimens. It is unlikely that any adverse outcomes would have resulted from delaying the routine pelvic examination and Papanicolaou smear. For example, the progression from cervical intraepithelial neoplasia grade 1 to more invasive disease takes years.

Our results suggest that routine annual pelvic examinations may not be necessary for young asymptomatic women. Screening for sexually transmitted diseases by pelvic examination is useful, since 7 percent of our subjects had either chlamydial or gonococcal infection, but screening with examination of first-catch urine specimens (or perhaps vaginal-swab specimens) could be particularly attractive if expensive pelvic examinations were not required. We hope this report stimulates an evaluation of the need for routine pelvic examinations in healthy, young, sexually active women who should be screened for sexually transmitted diseases.

Julius Schachter, Ph.D.
Mary-Ann Shafer, M.D.
Myra Young, M.A.
Mary Ott, M.D.
University of California, San Francisco, San Francisco, CA 94143

2 References

1. 1

   Schachter J, Moncada J, Whidden R, et al. Noninvasive tests for diagnosis of Chlamydia trachomatis infection: application of ligase chain reaction to first-catch urine specimens of women. J Infect Dis 1995;172:1411-1414
   CrossRef | Web of Science | Medline

2. 2

   Smith KR, Ching S, Lee H, et al. Evaluation of ligase chain reaction for use with urine for identification of Neisseria gonorrhoeae in females attending a sexually transmitted disease clinic. J Clin Microbiol 1995;33:455-457
   Web of Science | Medline

Citing Articles (5)

Citing Articles

1. 1

   Carolyn L. Westhoff, Heidi E. Jones, Maryam Guiahi. (2011) Do New Guidelines and Technology Make the Routine Pelvic Examination Obsolete?. Journal of Women's Health 20:1, 5-10
   CrossRef

2. 2

   C. S. Todd, C. Haase, B. P. Stoner. (2001) Emergency department screening for asymptomatic sexually transmitted infections. American Journal of Public Health 91:3, 461-464
   CrossRef

3. 3

   Mary-Ann B. Shafer. (1998) Annual pelvic examination in the sexually active adolescent female: what are we doing and why are we doing it?. Journal of Adolescent Health 23:2, 68-73
   CrossRef

4. 4

   S.E. Perlman, J.A. Kahn, S.J. Emans. (1998) Should pelvic examinations and Papanicolaou cervical screening be part of preventive health care for sexually active adolescent girls?. Journal of Adolescent Health 23:2, 62-67
   CrossRef

5. 5

   Consuelo M. Beck-Sague, Carol E. Farshy, Toya K. Jackson, Lorin Guillory, Daniela Edelkind, Janice C. Bullard, Elena A. Urdez, Bess Jones, Kelli Francis, Alan Sievert, Stephen A. Morse, Carolyn M. Black. (1998) Detection of Chlamydia trachomatis cervical infection by urine tests among adolescents clinics. Journal of Adolescent Health 22:3, 197-204
   CrossRef