The Bimanual Exam
Getting a bimanual exam during a pelvic examination has become the usual routine, but many women don’t understand why they are being performed or if they are necessary every year.
During this exam, a gynecologist places two fingers into your vagina, places the other hand on top of your lower abdomen, then gently pushes your lower abdomen between two hands.
Gynecologists use this technique to check for the size, shape and mobility of your uterus and any changes in your ovaries, particularly ovarian cysts.
A bimanual exam is an effective way to feel for any other possible abnormalities in your uterus or the surrounding tissues such as endometriosis, fibroid tumors or other common gynelogical conditions.
The Debate over the Yearly Bimanual Exam
Most of us expect the bimanual exam when we are having our yearly pelvic examination. But is it really making a difference in women’s care?
This topic was debated during the 2015 NAMS conference by two distinguished gynecologists — each with some interesting viewpoints on the pros and cons of the yearly bimanual exam.
Pros:
Speaking for the use of a bimanual exam was Dr. Barbara Levy, M.D., vice president for Health Policy of the American Congress of Obstetricians and Gynecologists.
Levy said that there are many benefits to the yearly bimanual exam. Among them is the opportunity to discuss other issues (sexual, emotional, etc.) in a woman’s life. This builds trust and helps to develop a rapport with patients, particularly with older patients.
She does not consider the bimanual a waste of time as the patient is already undressed and it takes less than a minute to complete. Additionally, she feels that the “soft benefits” of education and exploration outweighs the short amount of time that it takes to perform the bimanual exam.
Cons:
Responding with a rebuttal was Dr. Molly Cooke, M.D., Professor of Medicine, Director of Education for Global Health Sciences, University of California, San Francisco.
Cooke said that most practitioners in women’s health have not progressed to the point where it’s openly acknowledged that annual bimanual exams are a waste of time. She feels that it’s a limited exam, and it doesn't provide any benefit in asymptomatic women.
She said, “Since around 1995, there have been studies that show the accuracy of the bimanual exam in diagnosing ovarian cancer is poor."
Cooke explained that doctors are still performing it because people hate change. She would prefer to take the time to create a dialogue with women who might try to avoid their yearly pelvic exam out of fear or discomfort.
Making an Informed Decision
Regardless of whether you choose to have a yearly bimanual exam or not, the point is to create a dialogue with your doctor so that you are able to make decisions you are comfortable with, and that are in your best interest.
There are definite benefits in continuing to do a yearly bimanual exam, despite any legitimate fears of having such an examination performed. Be sure to have a conversation with your doctor to help you feel comfortable with your final decision.
Reviewed December 1, 2015
by Michele Blacksberg RN
Edited by Jody Smith