Male physicians may be less likely compared with female physicians to perform pelvic examinations in female patients with lower urinary tract symptoms, according to a study.
In the qualitative mixed-methods study, researchers surveyed 653 consultant urologists and urology trainees across Australia and New Zealand—about 11% (n = 74) of whom responded—and conducted semistructured interviews to assess examination practices and attitudes. Lower urinary tract symptoms (LUTS) include storage, voiding, and postmicturition symptoms. While most physicians reported routinely performing digital rectal examinations in male patients with LUTS, just 8.7% of male physicians reported routinely performing pelvic examinations in female patients compared with 85.7% of female physicians.
The primary outcome was physician-reported responsesto the survey assessing routinely performed pelvic and digital rectal examinations at the initial visit. The researchers assessed the barriers, attitudes, and perceived risks associated with pelvic examinations identified through the interviews.
Differences in practice were specific to female patients. Rates of digital rectal examinations among male patients were similar between male and female physicians(89.1% vs 92.9%), but the gap in the use of pelvic examinations was pronounced. Male physicians were also more likely to report using chaperones during pelvic examinations, access to which was frequently described as a logistical barrier.
Interview findings identified two main themes: barriers and fear. In addition to the limited access to chaperones, teported barriers included time constraints, concerns for patient discomfort, and perceptions that pelvic examinations had limited clinical utility or wouldn't change management. Some physicians reported deferring examinations to procedural settings rather than performing them at the initial visit.
Fear-related concerns included medicolegal risk, patient and physician discomfort or reluctance, as well as lack of training and role modeling from senior counterparts.
The researchers noted that pelvic examinations are recommended in guidelines for evaluating patients with LUTS and may identify findings not apparent from medical history alone, although some physicians perceived the examination as low yield.
Limitations included a low response rate, reliance on self-reported practices, and a sample limited to Australia and New Zealand, which may have affected generalizability. The findings reflected respondent perspectives and may not represent the broader urology workforce.
The researchers suggested that there was variation in examination practices in patients with LUTS and highlighted reported barriers that may influence whether pelvic examinations are performed.
“Barriers to pelvic examination need to be addressed to enable female patients to receive optimal care. Focused training and increased expectations may help prevent unnecessary procedures and improve patient outcomes,” wrote lead study author Kathryn McLeod, MBBS, MSurgEd, of the Department of Urological Surgery at Barwon Health at the University Hospital in Geelong, Australia, and colleagues.
The study authors reported no conflicts of interest.
Source: JAMA Open Network
