WHY IS COLONOSCOPY MORE DIFFICULT IN WOMEN

Background: In our experience colonoscopy in women is more difficult t han in men. A retrospective review of 2194 colonoscopies performed by a single experienced endoscopist (CBW) showed that 31% of examinations in women were considered technically difficult compared with 16% in m en. Methods: To investigate a possible anatomic basis for this finding , normal barium enema series from 183 female and 162 male patients wer e identified. From these barium enemas, measurements of colonic length and mobility were independently taken by two physicians who were unaw are of each patient's gender. Results: Total colonic length was greate r in women (median, 155 cm) compared to men (median, 145 cm), p = 0.00 5, despite women's smaller stature (p < 0.0001). Although there were n o significant differences in rectum plus sigmoid, descending, or ascen ding plus cecum segmental lengths, women had longer transverse colons (female median length, 48 cm; male median length, 40 cm), p < 0.0001. There were no differences in mobility of the descending colon and tran sverse colon between the sexes, but the transverse colon reached the t rue pelvis more often in women (62%) than in men (26%), p < 0.001. Con clusions: Colonoscopy appears to be a technically more difficult proce dure in women. The reason for this may be due in part to an inherently longer colon.