From the Guidelines
A genitourinary (GU) examination is generally not warranted in a patient presenting with headaches unless there are specific clinical indicators suggesting a connection between the headache and the genitourinary system. Such indicators might include headaches that coincide with urination (suggesting possible pheochromocytoma), headaches associated with sexual activity, or headaches in a patient with known genitourinary malignancy that could have metastasized to the brain. Additionally, if the patient has symptoms of a systemic condition that affects both neurological and genitourinary systems, such as systemic lupus erythematosus or vasculitis, a GU exam might be considered as part of a comprehensive evaluation. In most routine headache presentations, however, the clinical assessment should focus on neurological examination, vital signs (including blood pressure), and examination of the head and neck, as these are more directly relevant to identifying the cause of headaches. The decision to perform any examination should be guided by the patient's history, presenting symptoms, and clinical judgment rather than performing unnecessary examinations that don't contribute to diagnosis or management 1.
Some key points to consider when evaluating a patient with headaches include:
- The patient's medical history, including any previous diagnoses or conditions that could be related to the headaches
- The characteristics of the headaches, such as their frequency, severity, and any associated symptoms
- The results of any previous diagnostic tests or examinations
- The patient's overall health and any potential risk factors for underlying conditions that could be causing the headaches
It's also important to note that the evidence does not support the use of routine pelvic examinations in asymptomatic women, and that the potential harms of such examinations, including false-positive results and unnecessary diagnostic workup and treatment, should be carefully considered 1.
In terms of specific guidelines, the American College of Physicians recommends that clinicians consider the patient's individual circumstances and medical history when deciding whether to perform a GU examination, and that they should not rely solely on routine examinations or screening tests 1.
Overall, the decision to perform a GU examination in a patient with headaches should be based on a thorough evaluation of the patient's individual circumstances and medical history, and should be guided by the principles of evidence-based medicine and patient-centered care.
From the Research
Genitourinary Exam in Patients with Headaches
- A genitourinary (GU) exam is not typically warranted in patients presenting with headaches, as headaches are usually evaluated through a thorough history and physical examination to rule out red-flag features 2, 3.
- The primary focus of evaluating headaches is to determine whether they are primary (uncomplicated) or secondary to an underlying condition, and a GU exam is not a standard part of this evaluation 4.
- However, if a patient presents with systemic symptoms or signs that could be related to a genitourinary issue, such as a fever, weight loss, or abdominal pain, a GU exam may be considered as part of a broader diagnostic workup 5.
- In general, the decision to perform a GU exam in a patient with headaches would depend on the presence of specific symptoms or risk factors that suggest a genitourinary cause for the headaches, rather than the headaches themselves 6.
Specific Scenarios
- If a patient has a history of cancer or human immunodeficiency virus (HIV) infection, a GU exam may be considered as part of a comprehensive evaluation to rule out secondary causes of headaches 5.
- In patients over the age of 50, new-onset headaches may prompt a more thorough evaluation, including a GU exam, to rule out secondary causes such as subdural hematoma or stroke 6.
- However, in the absence of specific risk factors or symptoms, a GU exam is not typically necessary in the evaluation of headaches 2, 3.