Physicians hope to avoid unnecessary pelvic exams if pelvic inflammatory disease ruled out

April 13, 2004

WORCESTER, Mass.— Researchers at UMass Memorial Medical Center and the University of Massachusetts Medical School are investigating whether the diagnosis of pelvic inflammatory disease (PID) can be ruled out without performing a pelvic exam.  Chlamydia and gonorrhea, two sexually transmitted diseases that can lead to PID, are most prevalent among sexually active teenage girls—the very population least likely to seek medical treatment out of embarrassment or fear. Physicians are hoping to be able to provide accurate diagnoses of these and other genital infections using newer, non-invasive testing methods without subjecting patients to pelvic examinations.

PID, an infection of the upper genital tract that affects more than one million American women every year, is the most common and serious complication of bacterial sexually transmitted diseases.  PID can affect the uterus, ovaries and fallopian tubes and can cause scarring that leads to infertility, ectopic (tubal) pregnancy and chronic pelvic pain. Each year more than 100,000 women become infertile due to PID, and a large number of the 70,000 ectopic pregnancies reported annually are due to consequences of the disease.

In a study published in the journal Clinical Pediatrics, Lloyd D. Fisher, MD, a first-year resident in pediatrics, Diane R. Blake, MD, assistant professor of pediatrics, and Kenneth E. Fletcher, PhD, associate professor of psychiatry, sought to determine whether a review of a patient’s symptoms could be used to rule out PID and therefore preclude the need for a pelvic exam during the evaluation of gynecologic symptoms. 

In a retrospective chart review, the researchers found that 93% of adolescents and young adults who were diagnosed with PID had a documented report of one or more of the three major symptoms of the disease: abdominal pain, dyspareunia (pain during intercourse), or abnormal vaginal bleeding. This suggests that if the absence of the three symptoms were incorporated as a screening tool, many young women with lower genital tract symptoms could be evaluated without a bimanual pelvic exam. 

“Because a wide variety of genitourinary infections can have similar symptoms, the pelvic exam remains an essential tool in evaluating many patients with such complaints,” said Dr. Blake. “But if our results are replicated in larger studies, they could be used as a first-line screen to determine which young women with symptoms require a bimanual exam to evaluate for PID. Patients who do not have abdominal pain, dyspareunia and abnormal vaginal bleeding during the initial medical history are unlikely to meet the criteria for the diagnosis of PID.”

“It is our hope that by having other methods to rule out the diagnosis of PID that do not include a bimanual examination, young women will be willing to seek medical attention sooner,” said Dr. Fisher.  “This could significantly increase the detection of sexually transmitted diseases among this population and lead to earlier treatment, therefore reducing the incidence of infertility and other long-term consequences of these infections.”

UMass Memorial Health Care, Inc., is the largest not-for-profit health care delivery system in Central Massachusetts, comprised of 1,500 physicians and more than 12,000 employees. UMass Memorial’s comprehensive network of care includes a multi-campus tertiary hospital, owned and affiliated community hospitals, freestanding primary care practices, ambulatory outpatient clinics, long-term care facilities, home health agencies, hospice programs, a rehabilitation group, mental health services and a 700-member faculty group practice. UMass Memorial is the clinical partner of the University of Massachusetts Medical School.

Contact: Alison Duffy, Public Affairs and Publications, 508-856-2000