Point-Counterpoint
Annual pelvic examination in the sexually active adolescent female: what are we doing and why are we doing it?

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What is the problem?

Two thirds of adolescents reported sexual activity by Grade 12 in the Centers for Disease Control (CDC) Youth Risk Behavior Survey 1. We also know that 25% of all reported sexually transmitted diseases (STDs) occur in the sexually active adolescent. In the most recent CDC surveillance data, the gonorrheal rate among 15–19-year-old females is 757/100,000, or six times the overall population rate; and the chlamydial rate is 2068/100,000 or, seven times the overall population rate 2. Since only

How are we currently addressing the problem?

Sexually transmitted disease acquisition in the adolescent is a result of risky sexual behaviors. To adequately address prevention of STDs, it is necessary to invoke both primary prevention, i.e., delaying of the onset of sexual activity, limiting the number of partners and using condoms 100% of the time, and secondary prevention (i.e., identifying and treating asymptomatic STD infections). This discussion will focus upon the latter, the secondary prevention component of intervention to prevent

What are we doing and why are we doing it?

To begin to answer these questions, it is important to review the current state of the art of STD testing for gonorrhea and chlamydia. Currently, screening for these organisms is accomplished by the typical clinician with a pelvic examination, obtaining endocervical samples and identifying the organisms by culture, enzyme immunoassay (EIA), or, more recently, using the first-generation DNA probe tests. Focusing on chlamydia, the most common bacterial STD in the adolescent female, chlamydial

Anxiety and fear

What are the traditional indications for a pelvic examination in the adolescent female? As professionals caring for sexually active adolescents, we perform pelvic examinations for a number of reasons including assessment of menstrual irregularities, assessment of abnormal vaginal discharge, evaluation of abdominal pain, presence of dysuria and other genitourinary symptoms, evaluation of pregnancy, general assessment prior to prescribing contraception, STD screening, and to obtain a Papanicolau

Is HPV infection universal in teens?

It is known that HPV is the most common STD among adolescents and has been reported to infect 13–57% of sexually active adolescents 21, 22, including a rate of 15% among teens aged 13–19 years attending family planning clinics 23. Adolescents appear to have a similar spectrum of distribution of HPV types compared to adults with types 16–18 comprising one third to one half of all infections of the cervix 21. There appears to be a cumulative risk for infection with increasing age, so that up to

Are routine pelvic examinations cost-effective?

Recently, we completed an analysis which evaluated the cost-effectiveness comparing traditional pelvic examinations with endocervical sampling to urine-based samples to screen for STDs 28. The study used decision analysis to evaluate different possible strategies to approach the problem of screening for chlamydia and gonorrhea in a population of 100,000 healthy, asymptomatic, sexually active adolescent females. The outcome was the number of cases of pelvic inflammatory disease (PID) prevented

Summary

Questioning the need to perform pelvic examinations to screen for chlamydia and gonorrhea in the healthy, asymptomatic, sexually active adolescent females is an essential discussion at this time of advanced technology and limited resources. However, this discussion did not address several issues that were not central to the overall presentation. For example, we did not address the need to be receptive to the healthy adolescent who requests a pelvic examination or the need to perform pelvic

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  • Cited by (21)

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