Report: Rectal Exam Sensitivity Improved Without Gloves
Hard-to-detect lesions can be identified earlier

CLEVELAND, OH—Scientists at the Case Western Research Institute have determined that rectal exam sensitivity can be significantly improved if practitioners follow a simple guideline: Don’t wear gloves.

In an article appearing this week in Lancet, researchers reported the results of the two-year “Rectal Exams Are Mandatory (REAM)” study, in which thousands of patients were enrolled.

Dr. Lucy Casiano

According to the study methodology, physicians were first blindfolded, then randomly selected to wear either a normal glove (placebo arm), or a glove missing the index finger (study arm). Rectal exams were then performed, and findings were recorded and tabulated. At no time was the physician told which type of glove was being worn, although “some of them did figure it out,” acknowledges lead researcher Dr. Lucy Casiano.

“What we found was striking,” says Casiano. “Basically, a glove appears to really hinder these exams. You wind up missing a LOT of things. Like tiny little hemorrhoids you never even knew were there. Or, little irregularities in the shape of the prostate. While not clinically relevant for the most part, these are things we feel physicians ought to know about their patients.”

Based on the findings, Casiano’s group is recommending that all physicians either forgo the use of gloves entirely during rectal exams, or at least cut the index finger off from the gloves. Also recommended is that physicians who do a great number of rectal exams, e.g. gastroenterologists, should keep their fingernails neatly trimmed, as fecal material “tends to accumulate” under the nails.

“Doing rectal exams without gloves may sound a little repulsive at first,” added Casiano, “but we find that physicians eventually like the bonding experience it gives with their patients. And you’d be surprised – a little antibacterial hand gel goes a long way.”

Casiano's group plans next to determine whether Surgilube during rectal exams is really necessary. Also, although not yet specifically studied, experts predict that pelvic exams will be similarly improved without gloves, and funding for the necessary research is underway.