The Challenging Pelvic Examination
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While there is a large body of evidence on the effectiveness of Pap smears for cervical cancer screening and on screening for cervical gonorrhea and Chlamydia, there is sparse evidence to support other portions of the pelvic examination and little guidance on examination logistics. Maximizing comfort should be the goal; lubrication use and careful speculum selection and insertion can ease this intrusive procedure. This is particularly important in adolescent and menopausal women, sexual minorities, obese women, women with disabilities, and women with a history of trauma or prior instrumentation affecting the genitalia. We review the evidence and provide guidance to minimize physical and psychological discomfort with pelvic examination.
KeywordsSexual Minority Vaginal Wall Cervical Cancer Screening Vaginal Vault Pelvic Examination
The authors thank Lisa Iezzoni, MD, for her comments on our text on disabilities and Kim Ariyabuddhiphongs, MD, Diane Brockmeyer, MD, Jill Catalonotti, MD, and Amy Weinstein, MD, who worked with the authors on a 2008 SGIM workshop entitled “Teaching the Pelvic Exam: A Patient-Centered and Evidence-Based Approach to Training Medical Residents.”
Conflict of Interest
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