Effectiveness of Interventions to Improve Women's Experience of Pelvic Examinations: A Systematic Review and Meta-Analysis.

Abstract

Pelvic examinations are a routine element of gynaecological and obstetric care but may generate discomfort, pain and anxiety. Objectives To evaluate the effectiveness of interventions to improve women's experience of pelvic examinations. Search Strategy Medline, Cochrane Library, Embase, Web of Science and ScienceDirect were searched to identify randomised interventional trials published between January 1990 and December 2024. Selection Criteria Eligible studies compared an intervention group and control group of > 15-year-old women undergoing pelvic examinations and reported physical and emotional responses, such as pain, anxiety, discomfort and embarrassment. Data Collection and Analysis Two reviewers independently screened, extracted data, and assessed the risk of bias using the Cochrane Risk-of-Bias 2 (RoB2) tool. Data were analysed using pooled standardised mean differences (SMD) with 95% confidence intervals (CI) and random effects models. Heterogeneity was assessed with the I² statistic. Sixteen RCTs (4641 women) were analysed. Fourteen studies assessed interventions targeting women's perceptions: procedural strategies (n = 10), environmental adaptations (n = 2), and cognitive approaches (n = 2). Two studies evaluated the information provided to the patient about the examination and an online preparatory training (n = 2). The meta-analysis showed a significant reduction in pain (SMD -0.87, 95% CI -1.56 to -0.18; p = 0.001; 8 studies) and in anxiety (SMD -1.13, 95% CI -1.86 to -0.38; p = 0.003; 5 studies). Risk of bias was high (n = 5), some concerns (n = 4), and low (n = 7). Heterogeneity was high (pain: I² = 96.3%; anxiety: I² = 94.8%). Simple interventions may reduce pain and anxiety during pelvic examinations and support trauma-informed care, but the heterogeneous evidence requires more high-quality research.