title: Prospective comparative trial of endovaginal sonographic bimanual examination versus traditional digital bimanual examination in nonpregnant women with lower abdominal pain with regard to body mass index classification.
abstract: OBJECTIVE
  We hypothesized that a sonographic bimanual examination (SBME) would improve confidence in the pelvic examination in adult nonpregnant women with lower abdominal conditions compared to a traditional digital bimanual examination (DBME).
  
  
  METHODS
  In a prospective comparative study at an urban regional emergency department, an ultrasound-trained group of emergency clinicians performed both an SBME and a DBME on 30 women who required a DBME as part of their evaluation. Patients were divided into 3 groups based on their body mass index (BMI) weight class. Inclusion criteria included lower abdominal pain, age between 18 and 55 years, hemodynamic stability, and BMI of greater than 18.5. Exclusion criteria included pregnancy, hysterectomy, oophorectomy, and recent vaginal surgery. The patient's sequence of examinations was randomized and then performed by a different member of the study group. Examiners assessed their confidence (0%-100%) in 11 components of the pelvic examination.
  
  
  RESULTS
  There were higher scores for the SBME compared to the DBME in the overall composite score, cervical position, uterine size, uterine position, uterine tenderness, ovarian size, ovarian tenderness, and presence of an adnexal mass (P < .05), whereas cervical motion tenderness, cervical os opening, and rectovaginal tenderness did not show significant differences. Across BMI classes, the SBME produced high composite and individual examination scores among all examination criteria. In contrast, the DBME revealed significant differences for uterine size, uterine alignment, uterine tenderness, ovarian size, and ovarian tenderness across BMI classes (P < .05).
  
  
  CONCLUSIONS
  The SBME provides improved confidence in overall and key aspects of the pelvic examination across BMI classes compared to the DBME.
authors.affiliation: Department of Emergency Medicine, Carolinas Medical Center, Box 32861, Charlotte, NC 28232, USA. vtayal@carolinas.org
authors.forename: Vivek S
authors.initials: VS
authors.lastname: Tayal
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Crean
authors.forename: H James
authors.initials: HJ
authors.lastname: Norton
authors.forename: Christian J
authors.initials: CJ
authors.lastname: Schulz
authors.forename: Katrina N
authors.initials: KN
authors.lastname: Bacalis
authors.forename: Susan
authors.initials: S
authors.lastname: Bliss
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis*; D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D005260:Female; D006801:Humans; D008875:Middle Aged; D010173:Palpation / Q000379:methods*; D011247:Pregnancy; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013223:Statistics as Topic; D014463:Ultrasonography / Q000379:methods*; D014621:Vagina / Q000000981:diagnostic imaging*