Rectovaginal examination

• The rectovaginal examination has marked limitations despite the controlled circumstances of the operating room including general anaesthesia, an empty bladder and ideal patient positioning. As suspected, the specificity of the rectal examination is high due to the low prevalence of disease. However, the sensitivity of the rectovaginal examination is very low, limiting its capacity as a screening test. Both sensitivity and positive predictive value of the rectovaginal examination for detecting uterosacral nodularity were zero.
• The pelvic examination may include any of the following components, alone or in combination: assessment of the external genitalia, internal speculum examination, bimanual palpation, and rectovaginal examination. The USPSTF found inadequate evidence on the accuracy of pelvic examination to detect a range of gynecologic conditions.
• Although the digital rectal exam is commonly used as a way to obtain a stool sample for a FOBT in an office based setting, this is an insufficient way of screening for colorectal cancer and is not recommended. A single office-based FOBT performed following a digital rectal examination is not an adequate screen due to low sensitivity for advanced tumor and colorectal cancer. A paper published in the Journal of Internal Medicine states, "While FOBT done appropriately is an important screening option, in-office FOBT may be worse than no screening at all because it misses 95% of cases of advanced tumor, giving many patients a false sense of reassurance."