The National College of Gynecologists and Obstetricians revises its recommendations on pelvic examinations

in collaboration with

Dr Odile Bagot (Gynecologist-obstetrician)

Times are changing, and the way we perceive pelvic examinations by our doctor too. Thus, faced with the voices raised against painful pelvic examinations and touches, sometimes even carried out in a problematic setting (we should mention however that this is not a majority), the National College of French Gynecologists and Obstetricians (CNGOF) reacted by analyzing the subject scientifically… On January 25, the CNGOF issued its conclusions and recommendations intended for specialists, but also for general practitioners who are increasingly involved in gynecological follow-up, and for midwives. These tips are aimed at restoring trust with their patients.

Pelvic touch and speculum, more systematic in gynecological consultation

According to the new recommendations, the systematicity of vaginal examination and speculum should be reserved for very specific cases. 26 situations were thus detailed, of which the main ones are as follows:

• These pelvic examinations should not be essential for the prescription of hormonal contraception and its follow-up, on the other hand, they are recommended for the insertion and follow-up of an IUD. It is impossible to decide for the installation of a diaphragm, for lack of data;
• Beyond contraception, the pelvic examination should also not be systematic in the context of screening for ovarian cancer;
• It should no longer be systematic either, during pregnancy follow-up for an asymptomatic woman, without risk factor;
• The pelvic examination should not be systematic in postnatal consultation.

Vaginal examination and speculum are however recommended in cervical cancer screening, in case of suspected endometriosis, pelvic pain, abdominal or pelvic mass, chronic bleeding, emergency (to clarify the diagnosis and assess the severity) , urinary incontinence, prolapse or infertility. And in the case of pregnancy, in case of pain or bleeding.

Restoring confidence in the gynecological examination

The CNGOF also recommends asking patients about the existence of current or past violence, the pelvic examination being “lived less well (anxiety, discomfort, pain, embarrassment, shame) in women with a history of violence than in women without it”. But also to always clearly explain the need for an examination to his patient with the use of a speculum for example.

For Dr Olivier Multon, obstetrician gynecologist and vice-president of the CGNOF contacted by Doctissimo, the revision of the subject was important: “We saw a certain effervescence about the subjects of benevolence, consent, empathy, which called us to do even better. The pelvic examinations at the center of mis en cause, in particular in accusations of rape, challenged the profession. It was important to question our practice of pelvic touch, which had never been called into question in France, and to question it under the gaze of acquired scientific data, to know when it is necessary and when it is not. ‘is not.”

The notion of explanation and consent also seems to him to be essential today:

“The risk of missing masses or cysts”

Legitimate recommendations in our society, but which are not totally welcomed without reservations on the side of practitioners. For Dr. Odile Bagot, gynecologist and member of a committee of experts, the recommendation is quite audible with regard to pregnancy examinations which, without a history or complaints from the mother, do not need a vaginal examination. at each consultation. She is more cautious about routine gynecological consultations:

However, it insists on a common notion: “It should however be done in a framework of trust, well explained, and if done well, it should not cause pain.” she recalls.