Insightful Study Shows Why Many Women Aren't Getting Thorough Pelvic Exams for Urinary Symptoms

The Importance of the Pelvic Exam

When women visit urologists for lower urinary tract symptoms (LUTS)-which range from urgency and frequency to incontinence and discomfort-a pelvic examination is considered a gold standard for diagnosis. Such exams can reveal critical information about pelvic anatomy, prolapse, atrophy, and other causes that may not be apparent from history alone. Yet, how often are these best practices followed in real-world clinics?

A Gender Divide: What This Study Found

In a new mixed-methods study from Australia and New Zealand, researchers surveyed 74 urologists and trainees to discover who is performing pelvic and digital rectal exams in patients with LUTS. The results were striking:

Nearly all clinicians (both men and women) performed digital rectal exams for male patients.

Only 8.7% of male clinicians routinely conducted pelvic exams for female patients with LUTS, compared to 85.7% of female clinicians.

Both male and female clinicians cited needing a chaperone, logistical challenges, time pressure, or believing the exam would not change management as reasons for omission.

Why the Gap? Barriers and Fears Revealed

Through interviews, two major themes emerged:

Barriers: Male clinicians cited lack of chaperones, time constraints, and poor infrastructure as obstacles to conducting pelvic exams. Many felt that other diagnostic tools, such as cystoscopy, would suffice. Some admitted that their training rarely emphasized the need for pelvic exams in women, leading to a lack of confidence or habit.

Fear: Many male clinicians expressed discomfort or concern about patient embarrassment, and a significant fear of medicolegal repercussions if the examination was misunderstood. Female clinicians did not report similar fears when performing genital exams on males.

Impact on Patient Care

This gender divide has implications for patient outcomes. Without a pelvic exam, key diagnoses can be missed, leading to unnecessary investigations or interventions. While some clinicians believe that omitting the exam does not impact care, guidelines stress its importance for accurate assessment of LUTS in women. The study also found that the use of chaperones was much higher among male clinicians, adding further logistical complexity.

Moving Forward: Training and Patient-Centered Care

Experts argue that assumptions about patient discomfort are often unfounded—research shows bedside manner is more important than the clinician’s gender. The study recommends targeted training for all clinicians, improvements in clinic logistics, and a shift in workplace culture to ensure every patient receives the best possible evaluation.

5 Key Takeaways:

Male clinicians are far less likely than female clinicians to perform pelvic exams for women with urinary complaints.

Logistical barriers, lack of training, and medicolegal fears are common reasons for omission.

Not performing pelvic exams can delay or prevent accurate diagnosis and optimal treatment.

Chaperone use is much higher among male clinicians, complicating logistics.

Focused education and cultural change are needed to ensure women receive thorough, guideline-based urologic care.

Citation:

McLeod K, Youssef M, Rogers M, Grills R. Pelvic and Digital Rectal Examinations to Evaluate Lower Urinary Tract Symptoms. JAMA Network Open. 2026;9(4):e269267. doi:10.1001/jamanetworkopen.2026.9267