Limitations of the pelvic examination for evaluation of the female pelvic organs

To assess factors influencing an accurate pelvic examination under the best possible circumstances. Before undergoing laparoscopy or laparotomy, 84 women under general anesthesia underwent pelvic examinations by an attending gynecologist, a gynecology resident, and a medical student blinded to the indication for surgery. Surgical findings were compared with the examiners' findings. Dependent variables (uterine size, uterine contour, and presence of adnexal masses) and effect modifiers (examiner experience and body mass index) were analyzed. The overall pelvic examination was accurate 70.2% of the time for attending gynecologists, 64.0% for residents, and 57.3% for medical students. The sensitivity to detect adnexal masses was much lower than the sensitivity to assess uterine size or uterine contour. Obesity noticeably reduced detection of adnexal masses. The bimanual examination appears to be a limited screening test for the female upper genital tract even under the best possible circumstances. Uterine assessment appears to be more accurate than adnexal assessment.