CINXE.COM

<!DOCTYPE html> <html dir="ltr" lang="en"> <head> <meta http-equiv="X-UA-Compatible" content="IE=Edge"> <meta charset="utf-8"> <meta name="viewport" content="width=device-width, initial-scale=1"> <link rel="apple-touch-icon" sizes="180x180" href="/assets/images/favicons/apple-touch-icon.png"> <link rel="icon" type="image/png" href="/assets/images/favicons/favicon-32x32.png" sizes="32x32"> <link rel="icon" type="image/png" href="/assets/images/favicons/favicon-16x16.png" sizes="16x16"> <link rel="mask-icon" href="/assets/images/favicons/safari-pinned-tab.svg" color="#5bbad5"> <meta name="description" content="Youngwu Kim, MD, Milena M. Weinstein, MD, and a colleague present retrospective evidence that omitting a preoperative internal pelvic examination may be a clinically acceptable practice before gend..." > <title>Preop Internal Pelvic Exam and Safety of Gender-affirming Hysterectomy - Mass General Advances in Motion</title> <link rel="canonical" href="https://advances.massgeneral.org/obgyn/journal.aspx?id=2523"> <meta name="specialty-detail" content="OB/GYN|/obgyn/specialty.aspx?id=1006"> <meta name="specialty" content="OB/GYN"> <meta name="topic-detail" content="Gynecology|/obgyn/topic.aspx?id=1033"> <meta name="topic-detail" content="Transgender Health|/research-and-innovation/topic.aspx?id=1076"> <meta name="topic" content="Gynecology"> <meta name="topic" content="Transgender Health"> <meta name="pubDate" content="August 15, 2023"> <meta name="hubContentType" content="Journal"> <meta property="og:locale" content="en_US"> <meta property="og:url" content="https://advances.massgeneral.org/obgyn/journal.aspx?id=2523"> <meta property="og:site_name" content="Mass General Advances in Motion"> <meta property="og:title" content="Preop Internal Pelvic Exam and Safety of Gender-affirming Hysterectomy"> <meta property="og:description" content="Youngwu Kim, MD, Milena M. Weinstein, MD, and a colleague present retrospective evidence that omitting a preoperative internal pelvic examination may be a clinically acceptable practice before gend..."> <meta property="og:image" content="/obgyn/assets/feature-specialty_OBGYN_covid-pregancy_advances.jpg"> <meta property="og:article" content="OB/GYN"> <meta property="og:article" content="Gynecology"> <meta property="og:article" content="Transgender Health"> <meta property="article:publisher" content="http://www.facebook.com/massgeneral"> <meta name="twitter:card" content="summary"> <meta name="twitter:site" content="@MassGeneralNews"> <link href="/assets/styles/index.css" rel="stylesheet"> <link href="/assets/styles/jquery-ui-min.css" rel="stylesheet"> <link href="https://use.typekit.net/sgz4evs.css" rel="stylesheet"> <script> window.dataLayer = window.dataLayer || []; dataLayer = [{ 'postType': 'Journal', 'specialty': 'OB/GYN', 'topic': 'Gynecology,Transgender Health' }]; </script> <script src="/assets/scripts/jquery-3.2.1.min.js" ></script> </head> <body>  <a class="a11y-skip-link" href="#main-content">Skip to content</a>   <script type="text/javascript"> (function(window, document, dataLayerName, id) { window[dataLayerName]=window[dataLayerName]||[],window[dataLayerName].push({start:(new Date).getTime(),event:"stg.start"});var scripts=document.getElementsByTagName('script')[0],tags=document.createElement('script'); function stgCreateCookie(a,b,c){var d="";if(c){var e=new Date;e.setTime(e.getTime()+24*c*60*60*1e3),d="; expires="+e.toUTCString()}document.cookie=a+"="+b+d+"; path=/"} var isStgDebug=(window.location.href.match("stg_debug")||document.cookie.match("stg_debug"))&&!window.location.href.match("stg_disable_debug");stgCreateCookie("stg_debug",isStgDebug?1:"",isStgDebug?14:-1); var qP=[];dataLayerName!=="dataLayer"&&qP.push("data_layer_name="+dataLayerName),isStgDebug&&qP.push("stg_debug");var qPString=qP.length>0?("?"+qP.join("&")):""; tags.async=!0,tags.src="https://mgb.containers.piwik.pro/"+id+".js"+qPString,scripts.parentNode.insertBefore(tags,scripts); !function(a,n,i){a[n]=a[n]||{};for(var c=0;c<i.length;c++)!function(i){a[n][i]=a[n][i]||{},a[n][i].api=a[n][i].api||function(){var a=[].slice.call(arguments,0);"string"==typeof a[0]&&window[dataLayerName].push({event:n+"."+i+":"+a[0],parameters:[].slice.call(arguments,1)})}}(i[c])}(window,"ppms",["tm","cm"]); })(window, document, 'dataLayer', '41b8ae76-3079-47d5-aaf8-040ee367d152'); </script>  <header class="site-header" data-header="main"> <div class="site-header__nav-container"> <span class="site-header__logo"> <a href="https://www.massgeneral.org">Massachusetts General Hospital</a> </span> <div class="nav__primary__item -search mobile__search-toggle"> <button id="mobile__search-trigger" data-nav="trigger"> <span class="a11y-sr-only">Search</span> </button> </div> <button class="site-nav__toggle" aria-controls="site-navigation" aria-haspopup="true" aria-expanded="false" data-module="nav-toggle"> <span class="a11y-sr-only">Menu</span> </button> </div> <div class="site-header__sub-block" data-header="sub"> <p class="site-header__tagline"> <a href="/default.aspx">Advances in <i>Motion</i></a> </p> </div> <nav aria-label="Main navigation" class="site-nav" id="site-navigation"> <ul class="nav__utility" role="presentation"> <li><a href="/event-education-listing.aspx">Education & Training</a></li> <li><a href="/clinical-trial-listing.aspx">Clinical Trials</a></li> <li><a href="https://www.massgeneral.org/appointments-and-referrals/referral-request">Refer a Patient</a></li> <li><a href="https://www.massgeneral.org/doctors/">Find a Doctor</a></li> <li><a href="https://www.massgeneral.org/research/">Research Institute</a></li> <li><a class="nav__utility--highlight" href="https://advances.massgeneral.org/subscription.aspx">Subscribe</a></li> </ul> <ul class="nav__primary" data-module="navigation" role="presentation"> <li> <a class="nav__primary__trigger -home-link" href="/default.aspx"> <span class="nav__link-wrapper">Advances in Motion Home</span> </a> </li> <li class="nav__primary__item"> <a class="nav__primary__trigger" data-nav="trigger" data-nav-target="nav-specialties" href="/specialty-listing.aspx"> <span class="nav__link-wrapper">Specialties</span></a> <div class="nav__primary__dropdown" data-nav="target" id="nav-specialties"> <ul class="nav__primary__dropdown__links" role="presentation"> <li><a href="https://advances.massgeneral.org/cardiovascular/specialty.aspx?id=1002">Cardiovascular</a></li> <li><a href="https://advances.massgeneral.org/digestive-health/specialty.aspx?id=1007">Digestive Health</a></li> <li><a href="https://advances.massgeneral.org/endocrinology/specialty.aspx?id=1015">Endocrinology</a></li> <li><a href="https://advances.massgeneral.org/geriatrics/specialty.aspx?id=1009">Geriatrics & Palliative Care</a></li> <li><a href="https://advances.massgeneral.org/neuro/specialty.aspx?id=1004">Neuroscience</a></li> <li><a href="https://advances.massgeneral.org/obgyn/specialty.aspx?id=1006">OB/GYN</a></li> <li><a href="https://advances.massgeneral.org/oncology/specialty.aspx?id=1008">Oncology</a></li> <li><a href="https://advances.massgeneral.org/ophthalmology/specialty.aspx?id=1014">Ophthalmology</a></li> <li><a href="https://advances.massgeneral.org/ortho/specialty.aspx?id=1003">Orthopaedics</a></li> <li><a href="https://advances.massgeneral.org/otolaryngology/specialty.aspx?id=1016">Otolaryngology</a></li> <li><a href="https://advances.massgeneral.org/pulmonary/specialty.aspx?id=1012">Pulmonary & Critical Care</a></li> <li><a href="https://advances.massgeneral.org/radiology/specialty.aspx?id=1013">Radiology</a></li> <li><a href="https://advances.massgeneral.org/rheumatology/specialty.aspx?id=1010">Rheumatology, Allergy & Immunology</a></li> <li><a href="https://advances.massgeneral.org/urology/specialty.aspx?id=1005">Urology</a></li> </ul> <p class="fat-link__wrapper u-text-right"> <a class="fat-link -caret" href="/specialty-listing.aspx">View All Specialties</a> </p> </div> </li> <li class="nav__primary__item"> <a class="nav__primary__trigger" data-nav="trigger" data-nav-target="nav-topics" href="/topic-listing.aspx"> <span class="nav__link-wrapper">Topics</span> </a> <div class="nav__primary__dropdown -topics" data-nav="target" id="nav-topics"> <h4>Recently Updated</h4> <div class="nav__primary__dropdown__flex-container" id="topics-scroll-container"> <section class="flex-container__section"> <ul class="flex-container__links -alt" role="presentation"> <li> <a href="/research-and-innovation/topic.aspx?id=1114" target="_blank">Gene and Cell Therapy</a><p>November 5, 2024</p> </li> <li> <a href="/otolaryngology/topic.aspx?id=1113" target="_blank">Hearing Loss</a><p>November 5, 2024</p> </li> <li> <a href="/research-and-innovation/topic.aspx?id=1107" target="_blank">Women's Health</a><p>November 5, 2024</p> </li> <li> <a href="/neuro/topic.aspx?id=1038" target="_blank">Alzheimer's Disease</a><p>October 1, 2024</p> </li> <li> <a href="/neuro/topic.aspx?id=1018" target="_blank">Neurology</a><p>October 1, 2024</p> </li> <li> <a href="/oncology/topic.aspx?id=1059" target="_blank">Colorectal Cancer</a><p>September 11, 2024</p> </li> <li> <a href="/neuro/topic.aspx?id=1031" target="_blank">Depression</a><p>September 10, 2024</p> </li> <li> <a href="/neuro/topic.aspx?id=1017" target="_blank">Psychiatry</a><p>September 10, 2024</p> </li> <li> <a href="/neuro/topic.aspx?id=1029" target="_blank">Addiction</a><p>September 4, 2024</p> </li> <li> <a href="/neuro/topic.aspx?id=1043" target="_blank">Traumatic Brain Injury</a><p>September 2, 2024</p> </li> </ul> </section> <section class="flex-container__section"> <h5>Featured</h5> <ul class="flex-container__links" role="presentation"> <li> <a href="https://advances.massgeneral.org/ortho/topic.aspx?id=1009">Sports Medicine</a> </li> <li> <a href="https://advances.massgeneral.org/research-and-innovation/topic.aspx?id=1056">COVID-19</a> </li> <li> <a href="https://advances.massgeneral.org/neuro/topic.aspx?id=1024">Neurodegenerative Disease</a> </li> <li> <a href="https://advances.massgeneral.org/pulmonary/topic.aspx?id=1058">ARDS</a> </li> <li> <a href="https://advances.massgeneral.org/research-and-innovation/topic.aspx?id=1068">Telemedicine</a> </li> </ul> </section> </div> <p class="fat-link__wrapper u-text-right"> <a class="fat-link -caret" href="/topic-listing.aspx">View All Topics</a> </p> </div> </li> <li> <a class="nav__primary__trigger" href="/multimedia-listing.aspx"> <span class="nav__link-wrapper">Multimedia</span> </a> </li> <li class="nav__primary__item -search"> <a class="nav__primary__trigger" data-nav="trigger" data-nav-search data-nav-target="nav-search" href="/search.aspx"><span class="a11y-sr-only">Search</span></a> <div class="nav__primary__dropdown" data-nav="target" id="nav-search"> <p data-module="label-float"> <label for="site-search"> <span class="nav-search__label--desktop">What are you searching for?</span> <span class="nav-search__label--mobile">Search</span> </label> <input type="search" id="site-search" value=""> <button class="fat-button"><span class="a11y-sr-only">Submit</span></button> </p> </div> </li> </ul> </nav> </header>    <main class="site-main" id="main-content" tabindex="-1"> <div id="panelMainContent"> <article dcrname ="iwDCR0_071313"> <header class="-padding--horizontal" itemscope itemtype="http://schema.org/ScholarlyArticle"> <div class="content-header content-container -width--wide -centered"> <div class="tags"> <ul class="tag__list"> <li class="tag__item"> <a class="tag__link" href="/obgyn/topic.aspx?id=1033">Gynecology</a> </li> <li class="tag__item"> <a class="tag__link" href="/obgyn/specialty.aspx?id=1006">OB/GYN</a> </li> <li class="tag__item"> <a class="tag__link" href="/research-and-innovation/topic.aspx?id=1076">Transgender Health</a> </li> </ul> </div> <h1 class="content-header__heading" itemprop="name">Omission of Preoperative Internal Pelvic Exam May Not Affect Safety of Gender-affirming Hysterectomy</h1> <div class="content-header__metadata"> <p class="content-metadata"> <span class="content-metadata__media -journal">Journal</span> <time class="date" datetime="2023-08-15" itemprop="datePublished">Published on August 15, 2023 </time> </p> <p data-module="share-links"> </p> <p class="citation"> Originally published on <cite itemprop="citation"><a href="https://journals.lww.com/greenjournal/Abstract/2023/06000/Omission_of_Pelvic_Examination_Before.15.aspx">Obstetrics & Gynecology</a></cite> </p> </div> </div> </header> <div class="-padding--vertical -padding--horizontal"> <div class="layout-columns -width--wide -centered"> <div class="layout-columns__main"> <div class="layout-columns__main__content"> <div class="content-summary"> <h3 class="content-summary__heading">Key findings</h3> <ul> <li>This study compared the surgical outcomes of patients who did (n=29) or did not (n=33) undergo an internal pelvic examination within one year before gender-affirming hysterectomy (with or without vaginectomy) or vaginectomy alone</li> <li>There were no intraoperative complications, and the procedures were associated with relatively low rates of perioperative complications in both groups (length of surgery, estimated blood loss)</li> <li>Considering the small sample size, the study may be underpowered to detect differences in complication rates between the two groups</li> <li>Surgeons should consider whether an internal pelvic examination is necessary before gender-affirming hysterectomy and vaginectomy as an exam can act as a barrier to patient centered care</li> </ul> </div> <p>When transmasculine individuals undergo gender-affirming pelvic surgery, a preoperative internal pelvic examination is traditionally performed to guide the hysterectomy route and anticipate any challenges. However, many transmasculine individuals wish to avoid pelvic examinations because they elicit gender dysphoria. With greater use of telemedicine, pelvic examinations before gender-affirming surgery are often deferred to the operating room.</p><div class="article__signup-container"> <div class="email-signup-inline__container -background--white"> <style> #email-signup-inline { /* 540px */ background-image: url(/assets/raw/email-signup/cardiovascular-sub-callout.jpg); } @media only screen and (-webkit-min-device-pixel-ratio: 2), only screen and (min--moz-device-pixel-ratio: 2), only screen and (-moz-min-device-pixel-ratio: 2), only screen and (-o-min-device-pixel-ratio: 2/1), only screen and (min-device-pixel-ratio: 2), only screen and (min-resolution: 192dpi), only screen and (min-resolution: 2dppx) { #email-signup-inline { /* 1080 width */ background-image: url(/assets/raw/email-signup/cardiovascular-sub-callout.jpg); } } </style> <div class="content-container -width--wide -centered email-signup-inline__wrapper" id="email-signup-inline"> <div class="email-signup-inline__logo"> <img alt="Massachusetts General Hospital " src="/assets/logos/logo-white.svg"> </div> </div> <div class="email-signup-inline"> <h3 class="email-signup-inline__heading">Subscribe to the latest updates from OB/GYN Advances in Motion</h3> <p class="email-signup-inline__subheading"></p>  <meta http-equiv="Content-Type" content="text/html; charset=utf-8" /> <meta name="referrer" content="no-referrer-when-downgrade">  <script type="text/javascript" data-for="FA__DOMContentLoadedEventDispatch" src="https://massgeneral.tfaforms.net/js/FA__DOMContentLoadedEventDispatcher.js" defer></script> <script type="text/javascript"> document.addEventListener("FA__DOMContentLoaded", function(){ const FORM_TIME_START = Math.floor((new Date).getTime()/1000); let formElement = document.getElementById("tfa_0"); if (null === formElement) { formElement = document.getElementById("0"); } let appendJsTimerElement = function(){ let formTimeDiff = Math.floor((new Date).getTime()/1000) - FORM_TIME_START; let cumulatedTimeElement = document.getElementById("tfa_dbCumulatedTime"); if (null !== cumulatedTimeElement) { let cumulatedTime = parseInt(cumulatedTimeElement.value); if (null !== cumulatedTime && cumulatedTime > 0) { formTimeDiff += cumulatedTime; } } let jsTimeInput = document.createElement("input"); jsTimeInput.setAttribute("type", "hidden"); jsTimeInput.setAttribute("value", formTimeDiff.toString()); jsTimeInput.setAttribute("name", "tfa_dbElapsedJsTime"); jsTimeInput.setAttribute("id", "tfa_dbElapsedJsTime"); jsTimeInput.setAttribute("autocomplete", "off"); if (null !== formElement) { formElement.appendChild(jsTimeInput); } }; if (null !== formElement) { if(formElement.addEventListener){ formElement.addEventListener('submit', appendJsTimerElement, false); } else if(formElement.attachEvent){ formElement.attachEvent('onsubmit', appendJsTimerElement); } } }); </script> <link href="https://massgeneral.tfaforms.net/dist/form-builder/5.0.0/wforms-layout.css?v=20484c23150f9374e828ae7e95c879908749f33b" rel="stylesheet" type="text/css" /> <link href="https://massgeneral.tfaforms.net/uploads/themes/theme-7.css" rel="stylesheet" type="text/css" /> <link href="https://massgeneral.tfaforms.net/dist/form-builder/5.0.0/wforms-jsonly.css?v=20484c23150f9374e828ae7e95c879908749f33b" rel="alternate stylesheet" title="This stylesheet activated by javascript" type="text/css" /> <script type="text/javascript" src="https://massgeneral.tfaforms.net/wForms/3.11/js/wforms.js?v=20484c23150f9374e828ae7e95c879908749f33b"></script> <script type="text/javascript"> wFORMS.behaviors.prefill.skip = false; </script> <script type="text/javascript" src="https://massgeneral.tfaforms.net/wForms/3.11/js/localization-en_US.js?v=20484c23150f9374e828ae7e95c879908749f33b"></script>  <div class="wFormContainer" > <div class=""> <div class="wForm" id="528-WRPR" data-language="en_US" dir="ltr"> <div class="codesection" id="code-528"></div> <form method="post" action="https://massgeneral.tfaforms.net/api_v2/workflow/processor" class="hintsBelow labelsAbove" id="528"> <div class="oneField field-container-D " id="tfa_9-D"> <div aria-live="assertive"> <p class="marketo-signup__error"> Error: Please enter a valid email address. </p> </div> <p class="marketo-signup__input" data-module="label-float"> <label for="email-address"> Email Address </label> <input type="email" id="tfa_9" name="tfa_9" value="" data-marketo="email" > <button class="fat-button" type="submit" data-label="Submit" class="primaryAction" id="submit_button" value="Submit"> <span class="a11y-sr-only">Submit</span> </button> </p> <input type="hidden" id="tfa_10" name="tfa_10" value="Sub_OBGYN" class=""><input type="hidden" id="tfa_12" name="tfa_12" value="AiM Sub Box" class=""> </div> <div style="clear:both"></div> <input type="hidden" value="528" name="tfa_dbFormId" id="tfa_dbFormId"> <input type="hidden" value="" name="tfa_dbResponseId" id="tfa_dbResponseId"> <input type="hidden" value="43781862588d83a68a63d7320ba8ca55" name="tfa_dbControl" id="tfa_dbControl"> <input type="hidden" value="" name="tfa_dbWorkflowSessionUuid" id="tfa_dbWorkflowSessionUuid"> <input type="hidden" value="4" name="tfa_dbVersionId" id="tfa_dbVersionId"> <input type="hidden" value="" name="tfa_switchedoff" id="tfa_switchedoff"> </form> </div> </div> </div> <script id="open-telemetry-script" type="text/javascript" src="https://massgeneral.tfaforms.net/dist/open-telemetry/open-telemetry.152f594b0ae29ae89d4a.js" data-customer-id="1118" data-exporter-url="https://us-east-1-otel.formassembly.com/v1/traces" data-exporter-console="0" ></script> <script src="https://massgeneral.tfaforms.net/api_v2/sst/copy-and-paste"></script> </div> </div> </div> <p>Researchers at Massachusetts General Hospital have published evidence of the safety of omitting a preoperative internal pelvic examination before gender-affirming hysterectomy and vaginectomy.<span> </span><a title="Research contributions by Youngwu Kim, MD" href="https://advances.massgeneral.org/contributors/contributor.aspx?id=2382">Youngwu Kim, MD</a>, a urogynecologist in the<span> </span><a title="The Division of Female Pelvic Medicine and Reconstructive Surgery at Mass General" href="https://www.massgeneral.org/obgyn/treatments-and-services/female-pelvic-medicine-and-reconstructive-surgery-program">Division of Female Pelvic Medicine and Reconstructive Surgery</a><span> </span>in the<span> </span><a title="Department of Obstetrics and Gynecology at Mass General" href="https://www.massgeneral.org/obgyn/">Department of Obstetrics and Gynecology</a>,<span> </span><a title="Research contributions by Milena M. Weinstein, MD" href="https://advances.massgeneral.org/contributors/contributor.aspx?id=1240">Milena M. Weinstein, MD</a><a href="https://advances.massgeneral.org/contributors/contributor.aspx?id=1240" target="_blank" rel="noopener noreferrer">,</a><span> </span>co-director of the<span> </span><a title="Center for Pelvic Floor Disorders at Mass General" href="https://www.massgeneral.org/pelvic-floor/">Center for Pelvic Floor Disorders</a><span> </span>in the Department, and a resident doctor Ellen Murphy report the data in<span> </span><em><a title="Omission of Pelvic Examination Before Gender-Affirming Hysterectomy and Vaginectomy" href="https://journals.lww.com/greenjournal/Abstract/2023/06000/Omission_of_Pelvic_Examination_Before.15.aspx" target="_blank" rel="noopener noreferrer">Obstetrics & Gynecology</a>.</em></p> <h2>Methods</h2> <p>The team retrospectively studied all 62 patients, average age of 33, who underwent gender-affirming pelvic surgery performed at Mass General between April 2018 and March 2022. Twenty patients had hysterectomy alone, 18 had both hysterectomy and vaginectomy, and 24 had vaginectomy alone. All hysterectomies were performed laparoscopically.</p> <p>The "examined" group (n=29, 47%) was defined as patients with an internal pelvic examination performed during an in-person visit within one year before surgery. The other 33 patients were designated the "exam-omitted" group.</p> <h2>Patient Characteristics</h2> <p>The mean patient age was 33, most were white (86%), the mean body mass index was 29 kg/m<sup>2,</sup><span> </span>and the average time on testosterone therapy was six years. Two patients were parous.</p> <h2>Preoperative Care</h2> <p>Of the 38 patients who underwent hysterectomy, 19 had preoperative cervical cancer screening and three had a history of cervical dysplasia, all low-grade.</p> <p>The only statistically significant difference between the examined and exam-omitted groups was the type of preoperative visit: 32% of patients in the examined group vs. 68% in the exam-omitted group had preoperative telemedicine visits (P<0.001).</p> <p>Of the 33 patients in the exam-omitted group, three had a pelvic ultrasonogram before surgery as an alternative to internal examination. No findings changed the surgical approach or examination under anesthesia.</p> <h2>Complications</h2> <p>No intraoperative complication (ureteral, bladder, bowel, or vessel injury) was reported in the examined or exam-omitted group.</p> <p>The groups did not differ significantly in perioperative outcomes:</p> <ul> <li>Estimated blood loss—113 mL in the examined group vs. 135 mL in the exam-omitted group</li> <li>Operative time—141 vs. 130 minutes</li> <li>Emergency Department visit within 30 days—17% vs. 9%</li> <li>Surgical site infection within 30 days—7% vs. 9%</li> <li>Urinary tract infection within 30 days—14% vs. 3%</li> <li>Readmission within 30 days—14% vs. 6%</li> </ul> <h2>Suggestions for Surgeons</h2> <p>Surgeons are encouraged to rethink the necessity of an internal pelvic examination before gender-affirming hysterectomy and vaginectomy. In addition, a preoperative telemedicine visit seems to be a safe alternative to in-person visits and may further improve access to gender-affirming surgical care.</p> <p>As a caveat, because of the small sample size, the study may be underpowered to detect differences in complication rates between the two groups.</p><p class="fat-link__wrapper u-text-right"> <a class="fat-link -caret -large" href="https://journals.lww.com/greenjournal/Abstract/2023/06000/Omission_of_Pelvic_Examination_Before.15.aspx">view original journal article <em>Subscription may be required</em></a> </p> <div class="article-attribution" itemscope itemtype="http://schema.org/ScholarlyArticle"> <p class="article-attribution__logo" itemscope itemtype="http://schema.org/Periodical"> <a href="https://journals.lww.com/greenjournal/Abstract/2023/06000/Omission_of_Pelvic_Examination_Before.15.aspx"> <span class="a11y-sr-only" itemprop="name">Obstetrics & Gynecology</span> </a> </p> <p class="article-attribution__metadata" itemscope itemtype="http://schema.org/PublicationIssue"> <span> Journal Article Published: <time datetime="2023-06-01" itemprop="datePublished">June 1, 2023</time> </span> <span> Dates of Study: <time datetime="2018-04-01" itemprop="startDate">April 1, 2018</time> - <time datetime="2022-03-31" itemprop="endDate">March 31, 2022</time> </span> </p> </div> <p class="cta">Learn more about the <a href="https://www.massgeneral.org/obgyn/treatments-and-services/female-pelvic-medicine-and-reconstructive-surgery-program">Division of Female Pelvic Medicine and Reconstructive Surgery</a></p> <p class="cta">Refer a patient to the <a href="https://www.massgeneral.org/obgyn/appointments-and-referrals">Mass General Department of Obstetrics and Gynecology</a></p> </div> </div> <aside class="layout-columns__sidebar -article__contributors"> <div class="layout-columns__sidebar__content"> <div class="profile-compact__wrapper"> <p class="u-no-margin"> <strong>Contributors</strong> </p> <div class="profile -compact" itemscope itemtype="http://schema.org/Person"> <div class="profile__content"> <h3 class="profile__name" itemprop="name"> <a href="/contributors/contributor.aspx?id=1240" itemprop="url">Milena M. Weinstein, MD ›</a></h3><p class="profile__title" itemprop="jobTitle">Director of Research, Female Pelvic Medicine and Reconstructive Surgery Fellowship, Co-director, Center for Pelvic Floor Disorders</p> </div> <p class="profile__image"> <img alt="Milena M. Weinstein, MD" itemprop="image" srcset="/assets/images/contributors/milena_weinstein_advances.png, /assets/images/contributors/milena_weinstein_advances_2x.png 2x" src="/assets/images/contributors/milena_weinstein_advances.png"> </p> </div> <div class="profile -compact" itemscope itemtype="http://schema.org/Person"> <div class="profile__content"> <h3 class="profile__name" itemprop="name"> <a href="/contributors/contributor.aspx?id=2382" itemprop="url">Youngwu Kim, MD ›</a></h3><p class="profile__title" itemprop="jobTitle">Obstetrician-Gynecologist, Division of Female Pelvic Medicine and Reconstructive Surgery, Massachusetts General Hospital, Instructor in Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School</p> </div> <p class="profile__image"> <img alt="Youngwu Kim, MD, Profile Photo" itemprop="image" srcset="/assets/images/contributors/young_wu_kim_advances.png, /assets/images/contributors/young_wu_kim_advances_2x.png 2x" src="/assets/images/contributors/young_wu_kim_advances.png"> </p> </div> </div> </div> </aside> <section class="topics-layout -article__related"> <div class="topics-layout__inner"> <div class="topics-layout__sidebar"> <h2 class="section-heading">Related topics</h2> </div> <div class="topics-layout__main"> <ul class="topics-list" data-module="topics-list"> <li><a href="/obgyn/topic.aspx?id=1033">Gynecology</a></li> <li><a href="/research-and-innovation/topic.aspx?id=1076">Transgender Health</a></li> </ul> </div> </div> </section> <section class="-padding--horizontal -padding--vertical -article__related"> <div class="layout-columns -width--wide -centered"> <div class="layout-columns__pod--half"> <div class="content-tease" itemscope itemtype="http://schema.org/ScholarlyArticle"> <p class="content-tease__topic"> <span class="highlight">Related</span> </p> <h3 class="content-tease__heading" itemprop="name"> <a href="/obgyn/article.aspx?id=1519" itemprop="url">Ensuring OB/GYN Care is Gender-affirming Care</a> </h3> <p itemprop="description"> <p><span>Massachusetts General Hospital physicians collaborate across disciplines to ensure that OB/GYN care for transgender patients is safe, inclusive, and affirming.</span></p></p> <p class="content-tease__related"> <a href="/obgyn/topic.aspx?id=1047" itemprop="relatedLink">Fertility</a>, <a href="/obgyn/topic.aspx?id=1033" itemprop="relatedLink">Gynecology</a>, <a href="/obgyn/specialty.aspx?id=1006" itemprop="relatedLink">OB/GYN</a>, <a href="/research-and-innovation/topic.aspx?id=1076" itemprop="relatedLink">Transgender Health</a> </p> <p class="content-metadata"> <span class="content-metadata__media -article">Article</span> <time class="date" datetime="2023-04-05" itemprop="datePublished">April 5, 2023</time> </p> </div> </div> <div class="layout-columns__pod--half"> <div class="content-tease" itemscope itemtype="http://schema.org/ScholarlyArticle"> <p class="content-tease__topic"> <span class="highlight">Related</span> </p> <h3 class="content-tease__heading" itemprop="name"> <a href="/endocrinology/journal.aspx?id=2445" itemprop="url">Novel Mouse Model Allows Comparison of Candidate Parathyroid Hormone Ligand Analogs</a> </h3> <p itemprop="description"> <p><span>Massachusetts General Hospital researchers have engineered a novel strain of mice that express the human parathyroid hormone 1 receptor (PTH1R) instead of the murine equivalent. These mice represent a potentially powerful new tool for developing PTH ligand analogs to treat bone and mineral ion metabolism diseases.</span></p></p> <p class="content-tease__related"> <a href="/endocrinology/specialty.aspx?id=1015" itemprop="relatedLink">Endocrinology</a>, <a href="/endocrinology/topic.aspx?id=1110" itemprop="relatedLink">Osteoporosis</a> </p> <p class="content-metadata"> <span class="content-metadata__media -journal">Journal</span> <time class="date" datetime="2023-03-14" itemprop="datePublished">March 14, 2023</time> </p> </div> </div> </div> </section> </div> </div> </article> </div> </main>  <footer class="site-footer"> <div class="-padding--horizontal"> <nav aria-label="Footer links" class="content-container -width--wide -centered -padding--bottom"> <ul class="footer__nav" role="presentation"> <li> <a href="https://www.massgeneral.org/about">About Mass General</a> </li> <li> <a href="https://www.massgeneral.org/about/support">Giving</a> </li> <li> <a href="https://www.massgeneral.org/news/">News</a> </li> <li> <a href="https://www.massgeneral.org/notices/terms-of-use">Terms of Use</a> </li> <li> <a href="/contact-us.aspx">Contact Us</a> </li> </ul> </nav> <div class="content-container -width--wide -centered -padding--bottom"> <p class="u-text-centered"> <a class="footer__logo" href="http://www.massgeneral.org"> <img alt="MGH" src="/assets/images/logo-color.svg"> <span class="a11y-sr-only">Massachusetts General Hospital</span> </a> </p> <ul class="footer__social" role="presentation"> <li> <a href="https://twitter.com/MassGeneralNews"> <svg width="19" height="15" xmlns=http://www.w3.org/2000/svg viewBox="0 0 18.81 17"><path d="m14.81,0h2.89l-6.3,7.2,7.41,9.8h-5.8l-4.55-5.94-5.2,5.94H.37l6.74-7.7L0,0h5.95l4.11,5.43L14.81,0Zm-1.01,15.28h1.6L5.08,1.63h-1.72l10.43,13.64Z"/></svg> </a> </li> <li> <a href="https://www.facebook.com/massgeneral/"> <svg xmlns="http://www.w3.org/2000/svg" width="9" height="19"><path fill-rule="evenodd" fill="#007EA3" d="M0 6.284h1.929V4.373c0-.84.021-2.139.621-2.943C3.182.578 4.05 0 5.543 0 7.975 0 9 .353 9 .353l-.482 2.911s-.804-.237-1.554-.237-1.421.273-1.421 1.037V6.284h3.075l-.215 2.841h-2.86V19H1.929V9.125H0V6.284z"/></svg> </a> </li> <li> <a href="http://www.youtube.com/user/MassGeneralHospital"> <svg xmlns="http://www.w3.org/2000/svg" width="23" height="17"><path fill-rule="evenodd" fill="#007EA3" d="M22.77 13.325s-.224 1.666-.914 2.399c-.875.963-1.855.968-2.305 1.024-3.218.244-8.051.252-8.051.252s-5.98-.057-7.82-.243c-.512-.101-1.661-.07-2.536-1.033-.69-.733-.914-2.399-.914-2.399S0 11.369 0 9.413V7.579c0-1.956.23-3.912.23-3.912s.224-1.665.914-2.399C2.019.306 2.999.301 3.448.244 6.667 0 11.495 0 11.495 0h.01s4.828 0 8.046.244c.45.057 1.43.062 2.305 1.024.69.734.914 2.399.914 2.399S23 5.623 23 7.579v1.834c0 1.956-.23 3.912-.23 3.912zm-8.519-4.481L9.124 5.246l.001 6.389 5.126-2.791zm-5.127-4v.358l5.887 3.228.328-.179-6.215-3.407z"/></svg> </a> </li> <li> <a href="https://www.linkedin.com/company/massachusetts-general-hospital"> <svg xmlns="http://www.w3.org/2000/svg" width="18" height="18"><path fill-rule="evenodd" fill="#007EA3" d="M14.273 18v-5.846c0-1.396-.027-3.188-1.939-3.188-1.94 0-2.236 1.518-2.236 3.085V18H6.371V5.977h3.575v1.642h.052c.498-.945 1.715-1.941 3.53-1.941 3.775 0 4.472 2.49 4.472 5.728V18h-3.727zM2.164 4.333A2.164 2.164 0 0 1 0 2.166a2.164 2.164 0 1 1 4.327 0 2.166 2.166 0 0 1-2.163 2.167zM4.031 18H.296V5.977h3.735V18z"/></svg> </a> </li> <li> <a href="https://www.doximity.com/pages/hospitals/ma/boston/massachusetts-general-hospital"> <svg xmlns="http://www.w3.org/2000/svg" width="17.583" height="18" viewBox="8.024 95.826 17.583 18"><g fill="#007EA3"><path d="M23.207 104.657c.034-.062.02-.115.02-.168v-5.142c0-.413.173-.586.58-.586h1.278c.34 0 .523.178.523.52v13.803c0 .332-.178.52-.51.52-.45.004-.9.004-1.353 0-.32 0-.513-.197-.513-.52v-1.368c-.062.03-.087.077-.115.12-.442.614-.965 1.138-1.632 1.498-.788.427-1.637.557-2.52.46-1.215-.13-2.232-.657-3.068-1.545-.725-.772-1.152-1.7-1.334-2.736-.207-1.147-.163-2.29.22-3.398.65-1.853 1.925-3.024 3.874-3.36 1.642-.288 3.058.197 4.176 1.464.13.134.245.283.374.437zm-3.216 7.137c1.13-.02 1.978-.47 2.597-1.334.658-.917.812-1.95.605-3.043-.302-1.58-1.59-2.81-3.35-2.698-.96.06-1.766.464-2.3 1.266-.9 1.354-.945 2.793-.182 4.214.557 1.047 1.494 1.566 2.63 1.594zM15.988 95.835c.355-.024.71.004 1.06.042.04.005.078.01.116.024.144.054.226.184.207.333-.023.144-.143.163-.258.173-.624.053-1.23.177-1.82.394-.993.365-1.885.902-2.71 1.555-1.1.864-2.056 1.862-2.81 3.048-.522.82-.93 1.69-1.118 2.65-.02.104-.033.215-.058.32-.024.107-.052.208-.187.227-.13.014-.265-.062-.317-.187-.053-.13-.053-.27-.058-.404-.058-1.244.12-2.45.605-3.6.33-.783.796-1.48 1.368-2.108 1.277-1.412 2.894-2.155 4.76-2.41.203-.03.41-.053.615-.062.202 0 .403.005.605.005zM11.342 105.18c.014-1.512.494-2.842 1.53-3.96.84-.907 1.883-1.44 3.083-1.69.687-.144 1.383-.168 2.08-.1l.104.013c.143.03.24.125.23.24-.015.148-.145.144-.25.163-.173.024-.35.04-.52.072-.916.178-1.727.586-2.48 1.124-.918.658-1.71 1.435-2.343 2.37-.485.716-.854 1.48-.984 2.344-.015.105-.024.23-.178.23-.14 0-.216-.09-.24-.26-.04-.176-.028-.364-.033-.546z"/></g></svg> </a> </li> </ul> <p class="footer__address"> <a href="https://www.google.com/maps/dir/''/55+Fruit+St,+Boston,+MA+02114/@42.3631581,-71.0710274,17z/data=!3m1!4b1!4m8!4m7!1m0!1m5!1m1!1s0x89e370999524529b:0x10e737717f2daf80!2m2!1d-71.0688334!2d42.3631542" itemprop="address" itemscope itemtype="http://schema.org/PostalAddress"> <span itemprop="streetAddress">55 Fruit Street</span> <span itemprop="addressLocality">Boston</span>, <span itemprop="addressRegion">MA</span> <span itemprop="postalCode">02114</span> </a> <span class="footer__phone"> Phone: <a href="tel:6177262000" itemprop="telephone">617-726-2000</a> </span> </p> <p> Copyright © 2007-2024. The General Hospital Corporation. All Rights Reserved. </p> </div> </div> <div class="content-container -padding--horizontal -padding--vertical -background--grey"> <ul class="footer__partners -width--wide -centered" role="presentation"> <li> <a href="https://www.massgeneral.org/education/about"> <img alt="Harvard teaching hospital logo" src="/assets/images/logo-hms.svg" width="170"> </a> </li> <li> <a href="https://www.massgeneralbrigham.org/"> <img alt="Mass General Brigham logo" src="/assets/images/MassGeneralBrigham-grey.svg" width="200"> </a> </li> <li> <a href="https://www.massgeneral.org/about/leadership"> <img alt="Physicians" src="/assets/images/logo-physicians.svg" width="177"> </a> </li> <li> <a href="http://protomag.com/"> <img alt="Proto Magazine Logo" src="/assets/images/logo-proto.svg" width="117"> </a> </li> </ul> </div> </footer> <script src="/assets/scripts/index.js"></script>  </body> </html>