Are you ethical?: that may depend on who you are asking

Last week, I was stopped at a red light on a 2-lane street with construction barriers on both sides of my lane. Behind me, approaching fast, was an ambulance with its siren wailing. In the oncoming lane, also stopped at the red light, was a police car. Since I could not pull off to the right because of the barrier, my only choice to get out of the path of the ambulance was to drive into the intersection despite the red light. However, if I did, I would be breaking the law in clear view of a police officer. But if I did not let the ambulance through, I would be violating an ethical norm. After quickly thinking through my options, I made a judgment call and did what I thought best. What would you do?     

If you could see what we see,would it bother you?

Objective

The purpose of our study was to determine whether the anatomic threshold for pelvic organ prolapse (POP) diagnosis and surgical success remains valid when the patient sees what we see on exam.

Methods

Two hundred participants were assigned, by computer-generated block randomization, to see one of four videos. Each video contained the same six clips representative of various degrees of anterior vaginal wall support. Participants were asked questions immediately after each clip. They were asked: “In your opinion, does this patient have a bulge or something falling out that she can see or feel in the vaginal area?” Similarly, they were asked to give their opinion on surgical outcome on a 4-point Likert scale.

Results

The proportion of participants who identified the presence of a vaginal bulge increased substantially at the level of early stage 2 prolapse (1 cm above the hymen), with 67 % answering yes to the question regarding bulge. The proportion of participants who felt that surgical outcome was less desirable also increased substantially at early stage 2 prolapse (1 cm above the hymen), with 52 % describing that outcome as “not at all” or “somewhat” successful.

Conclusion

Early stage 2 POP (1 cm above the hymen) is the anatomic threshold at which women identify both a vaginal bulge and a less desirable surgical outcome when they see what we see on examination.