Diagnosis of pelvic inflammatory disease and barriers to conducting pelvic examinations in Australian general practice: findings from an online survey
Helen Bittleston
A E , Jacqueline Coombe A , Meredith Temple-Smith B , Deborah Bateson C , Jill Hunady D , Lena Sanci B , Jane S. Hocking A and Jane L. Goller A
A Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, Vic. 3053, Australia.
B Department of General Practice, The University of Melbourne, 780 Elizabeth Street, Carlton, Vic. 3010, Australia.
C Family Planning NSW, 328-336 Liverpool Road, Ashfield, NSW 2131, Australia.
D True Relationships and Reproductive Health, 230 Lutwyche Road, Windsor, Qld 4030, Australia.
E Corresponding author. Email: helen.bittleston@unimelb.edu.au
Sexual Health 18(2) 180-186 https://doi.org/10.1071/SH20176
Submitted: 23 September 2020 Accepted: 19 February 2021 Published: 9 April 2021
Abstract
Background: Pelvic inflammatory disease (PID) is under-diagnosed globally, particularly in primary care, and if untreated may cause reproductive complications. This paper investigates PID diagnosis by Australian general practitioners (GPs) and barriers to their conducting a pelvic examination. Methods: An online survey investigating Australian GPs’ chlamydia management, including PID diagnosis, was conducted in 2019. From 323 respondents, 85.8% (n = 277) answered multiple-choice questions about PID and 74.6% (n = 241) answered a free-text question about barriers to conducting pelvic examinations. Using multivariable logistic regression, we identified factors associated with conducting pelvic examinations. Barriers to performing pelvic examinations were explored using thematic analysis. Results: Most GPs indicated that they routinely ask female patients with a sexually transmissible infection about PID symptoms, including pelvic pain (86.2%), abnormal vaginal discharge (95.3%), abnormal vaginal bleeding (89.5%), and dyspareunia (79.6%). Over half reported routinely conducting speculum (69.0%) and bimanual pelvic (55.3%) examinations for women reporting pelvic pain. Female GPs were more likely to perform speculum [adjusted odds ratio (AOR) 4.6; 95%CI: 2.6–8.2] and bimanual pelvic examinations (AOR 3.7; 95%CI: 2.1–6.5). GPs with additional sexual health training were more likely to routinely perform speculum (AOR 2.2; 95%CI: 1.1–4.2) and bimanual pelvic examinations (AOR 2.1; 95%CI: 1.2–3.7). Barriers to pelvic examinations were patient unwillingness and/or refusal, GP gender, patient health-related factors, time pressures, and GP reluctance. Conclusion: Although GPs typically ask about PID symptoms when managing patients with chlamydia, they are not consistently able or willing to perform pelvic examinations to support a diagnosis, potentially reducing capacity to diagnose PID.
Keywords: chlamydia, general practice, pelvic examinations, pelvic inflammatory disease, PID, reproductive health, women’s health.
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