Rectovaginal examination

A rectovaginal examination is a type of gynecological examination used to supplement a pelvic examination. In the rectovaginal examination, a doctor or other health care provider places one finger in the vagina and another in the rectum to assess the rectovaginal septum. The examiner will look for any scarring or masses that may indicate cancer or another disease. Typically, a rectovaginal examination is performed to assess pelvic pain, rectal symptoms, or a pelvic mass. It can also provide a sample for fecal occult blood testing.[1]

Usage as a screening test in asymptomatic women

  • The rectovaginal examination has marked limitations despite the controlled circumstances of the operating room including general anaesthesia, an empty bladder and ideal patient positioning. As suspected, the specificity of the rectal examination is high due to the low prevalence of disease. However, the sensitivity of the rectovaginal examination is very low, limiting its capacity as a screening test. Both sensitivity and positive predictive value of the rectovaginal examination for detecting uterosacral nodularity were zero. [2]
  • The pelvic examination may include any of the following components, alone or in combination: assessment of the external genitalia, internal speculum examination, bimanual palpation, and rectovaginal examination. The USPSTF found inadequate evidence on the accuracy of pelvic examination to detect a range of gynecologic conditions. [3]
  • Although the digital rectal exam (DRE) is commonly used as a way to obtain a stool sample for a FOBT (fecal occult blood test) in an office based setting, this is an insufficient way of screening for colorectal cancer and is not recommended.[4][5][6] A single office-based FOBT (fecal occult blood test) performed following a digital rectal examination (DRE) is not an adequate screen due to low sensitivity for advanced tumor and colorectal cancer.[7] A paper published in the Journal of Internal Medicine states, "While FOBT done appropriately (taken home and used according to the instructions) is an important screening option, in-office FOBT may be worse than no screening at all because it misses 95% of cases of advanced tumor, giving many patients a false sense of reassurance."[8]

References
  1. Hoffman, Barbara L.; Schorge, John O.; Schaffer, Joseph I.; Halvorson, Lisa M.; Bradshaw, Karen D.; Cunningham, F. Gary (2012). "Well Woman Care". Williams Gynecology (2nd ed.). McGraw Hill Medical. p. 6. ISBN 978-0-07-171672-7.
  2. Milad, M. P.; Padilla, L. A.; Dragisic, K. G. (2003-08-01). "The accuracy of the rectovaginal examination in detecting cul‐de‐sac disease in patients under general anaesthesia". Human Reproduction. 18 (8): 1712–1715. doi:10.1093/humrep/deg350. ISSN 0268-1161. PMID 12871888.
  3. Tseng, Chien-Wen; Siu, Albert L.; Simon, Melissa; Silverstein, Michael; Phipps, Maureen G.; Phillips, William R.; Mangione, Carol M.; Landefeld, C. Seth; Kurth, Ann E. (2017-03-07). "Screening for Gynecologic Conditions With Pelvic Examination: US Preventive Services Task Force Recommendation Statement". JAMA. 317 (9): 947–953. doi:10.1001/jama.2017.0807. ISSN 0098-7484. PMID 28267862.
  4. Wender, R. C. (2006). "Colorectal cancer screening: Don't just do it, do it right". American Family Physician. 73 (10): 1707–8. PMID 16734049.
  5. Ashraf, Imran; Paracha, Shafaq R.; Arif, Murtaza; Choudhary, Abhishek; Matteson, Michelle L.; Clark, Robert E.; Godfrey, Jonathan D.; Hammad, Hazem T.; Bechtold, Matthew L. (2012). "Digital Rectal Examination Versus Spontaneous Passage of Stool for Fecal Occult Blood Testing". Southern Medical Journal. 105 (7): 357–361. doi:10.1097/SMJ.0b013e31825bfdc5. PMID 22766663.
  6. Nadel, Marion R.; Shapiro, Jean A.; Klabunde, Carrie N.; Seeff, Laura C.; Uhler, Robert; Smith, Robert A.; Ransohoff, David F. (2005). "A National Survey of Primary Care Physicians' Methods for Screening for Fecal Occult Blood". Annals of Internal Medicine. 142 (2): 86–94. doi:10.7326/0003-4819-142-2-200501180-00007. PMID 15657156.
  7. Collins, Judith F.; Lieberman, David A.; Durbin, Theodore E.; Weiss, David G.; Veterans Affairs Cooperative Study #380 Group (2005). "Accuracy of Screening for Fecal Occult Blood on a Single Stool Sample Obtained by Digital Rectal Examination: A Comparison with Recommended Sampling Practice". Annals of Internal Medicine. 142 (2): 81–5. doi:10.7326/0003-4819-142-2-200501180-00006. PMID 15657155.
  8. Nadel, Marion R.; Berkowitz, Zahava; Klabunde, Carrie N.; Smith, Robert A.; Coughlin, Steven S.; White, Mary C. (2010). "Fecal Occult Blood Testing Beliefs and Practices of U.S. Primary Care Physicians: Serious Deviations from Evidence-Based Recommendations". Journal of General Internal Medicine. 25 (8): 833–839. doi:10.1007/s11606-010-1328-7. PMC 2896587. PMID 20383599.
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