How to identify the uterosacral ligament…and more

The increased expense of this approach lies not in the cost of the US per se, but in the need for additional office visits and testing to “follow” the irregularities identified. Even in very high-risk patients, the use of US of the ovaries to screen for cancer has not been shown to improve outcomes.

That said, there may be some middle ground. The use of US to fine-tune the presumptive anatomic findings of the bimanual exam and to correlate the physiology of ovarian function (or lack thereof) with the endometrial response might enable a clinician to operate on a higher plane. However, if that clinician is using concepts that have not been validated (e.g., the questionable significance of simple ovarian cysts in postmenopausal women), then the incorporation of US into routine pelvic examination remains problematic.

If research demonstrates some advantage in detecting ovarian cysts, thickened endometrium, or pelvic fluid in patients with no symptoms, I could support the addition of routine US-guided pelvic examination. Absent guidelines for management of the expected cysts, fluid collections, and endometrial changes we will find in our asymptomatic patients, however, any improvement in the sensitivity of our exams with US will do nothing but drive costs, tests, and patient anxiety.

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