Stirrups may not be necessary for pelvic exams

Gynecologists can perform pelvic exams adequately without making women put their feet up in stirrups, a study suggests.

In the US, the norm is for women having a gynecological checkup to put their feet in stirrups on the side of the examining table and their bottom at the table's edge. Women felt less vulnerable and less uncomfortable, Army researchers found, when they keep their feet on the examining table and bow their legs outwards - and pelvic exams can be done equally well.

"It's obvious that this examination is much better for the patient from their standpoint," Dr. Dean Seehusen of the Eisenhower Army Medical Center in Fort Gordon, Georgia, the study's lead author, told Reuters Health.

The findings were published in BMJ in July, and are also described in the latest issue of the Harvard Women's Health Watch.

While critics have argued that Pap smears aren't as accurate when women are not in the stirrups position, Seehusen notes that the feet-on-the-table approach is standard in the UK and Australia, where Pap smear accuracy is no more of a problem than it is in this country.

Seehusen launched his study after a colleague told him she never had her patients use the stirrups for a pelvic exam. To evaluate the approach, they had 197 women undergo Pap smears with or without stirrups. The women rated their physical discomfort, sense of vulnerability and sense of control during the exam.

Women who had the exam without stirrups felt significantly less vulnerable and uncomfortable than the women who used the stirrups, although there was no difference in their sense of control.

Seehusen suggests that if a woman's experience of her pelvic exam is less unpleasant, she will be more likely to come in for regular care. "They've definitely shown that fear of pain, fear of embarrassment are at least some of the reasons why women don't come in and get those exams," he noted.

He and his colleagues are planning studies to evaluate the accuracy of Pap smears done via the non-stirrup approach.

SOURCE: Harvard Women's Health Watch, October 2006.