Pelvic exam in the ED

The value of the pelvic exam for emergency department patients has been investigated in a few studies. Brown et al West J Emerg Med 2011;12(2):208 looked at 183 women with acute abdominal pain or vaginal bleeding who underwent pelvic exam. They found that only 6% (12 cases) had an unexpected finding on exam that led to a change in management. Linden et al Ann Emerg Med 2017;70(6):825 randomized 202 women in early pregnancy with abdominal pain or vaginal bleeding to pelvic or no pelvic exam. They found no significant difference in a composite morbidity outcome, although their power was insufficient and their confidence intervals were wide. Farrukh et al Ann Emerg Med 2018;72(6):703 studied 288 patients aged 14-20 years old with pelvic pain or vaginal discharge. They found that pelvic exam did not improve on the sensitivity/specificity for diagnosing cervicitis and PID beyond simple history and urine NAT tests for chlamydia, gonorrhea, and trichomonas (27.4% of the population had an STD), although in 71 patients the results of the pelvic exam changed medical management.