title: Obstetrician-Gynecologist Practices and Beliefs Regarding External Genitalia Inspection and Speculum Examinations in Healthy Older Asymptomatic Women.
abstract: OBJECTIVE
  To understand obstetrician-gynecologist perceptions of the value of external genitalia inspection and speculum examinations in older and younger healthy women across the life span.
  
  
  METHODS
  National survey from May 2010 to January 2011 asking obstetrician-gynecologists about the need for and importance of external inspection and speculum examination in four scenarios of asymptomatic healthy women aged 70, 55, 35, and 18 who present for routine health visits. Separate questions asked about the importance of various reasons for these examinations.
  
  
  METHODS
  Mail-in survey of a national sample of obstetrician-gynecologists.
  
  
  METHODS
  Probability sample of obstetrician-gynecologists from the American Medical Association Physician Masterfile (N = 521).
  
  
  METHODS
  Proportion of obstetrician-gynecologists who would perform external inspection and speculum examinations and consider these examinations to be very important.
  
  
  RESULTS
  The response rate was 62%. In a healthy 70-year-old woman, 98% of respondents would perform external inspection, and 86% would perform a speculum examination. Ninety percent would perform a speculum examination in a healthy 55-year-old woman after removal of her uterus, cervix, and ovaries. Respondents more often indicated that the external examination was very important in the 70-year-old (63%) than in younger women (46-53%). Reasons rated as very important included identifying cancers and benign lesions, reassuring women of their health, and adhering to standard of care.
  
  
  CONCLUSIONS
  Obstetrician-gynecologists would commonly perform external and speculum examinations in asymptomatic women and believe the external examination to be particularly important in older women for cancer detection. Clinicians should discuss limitations of screening pelvic examination guidelines and elicit health goals from older women to provide more person-centered gynecological care.
authors.affiliation: Division of Geriatrics, Veterans Affairs Medical Center, San Francisco, California.
authors.forename: Amy
authors.identifier: http://orcid.org/0000-0002-6092-7321
authors.initials: A
authors.lastname: Hsu
authors.affiliation: Kaiser Permanente Center for Health Research, Portland, Oregon.
authors.forename: Jillian T
authors.initials: JT
authors.lastname: Henderson
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, University of California at San Francisco, San Francisco, California.
authors.forename: Cynthia C
authors.initials: CC
authors.lastname: Harper
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, University of California at San Francisco, San Francisco, California.
authors.forename: George F
authors.initials: GF
authors.lastname: Sawaya
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005831:Genital Diseases, Female / Q000175:diagnosis*; D058869:Gynecological Examination; D006176:Gynecology; D006801:Humans; D008875:Middle Aged; D009774:Obstetrics; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D013525:Surgical Instruments; D011795:Surveys and Questionnaires; D014481:United States; D016387:Women's Health
keywords: asymptomatic; obstetrics-gynocology; pelvic exam; women