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
- 10.U.S. Preventive Services Task Force. Screening for Cervical Cancer, Topic Page. January 2003. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/uspstf/uspscerv.htm accessed 11/29/09
- 11.U.S. Preventive Services Task Force. Screening for Ovarian Cancer: Recommendation Statement. May 2004. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/uspstf/uspsovar.htm accessed 11/29/09
- 12.Practice Bulletin No. 109: Cervical cytology screening. Obstet Gynecol. 2009;113:1409–20.Google Scholar
- 16.Brown T, Herbert ME. Medical myth: bimanual pelvic examination is a reliable decision aid in the investigation of acute abdominal pain or vaginal bleeding. Can J Emerg Physicians. 2003;5:120–2.Google Scholar
- 19.Broadmore J, Carr-Gregg M, Hutton JD. Vaginal examinations: women’s experiences and preferences. NZ Med J. 1986;99:8–10.Google Scholar
- 22.Intimate examinations. London: General Medical Council Standards Committee, December 2001.Google Scholar
- 23.Gynaecological examinations: guidelines for specialist practice. London: Royal College of Obstetricians and Gynaecologists, July 2002.Google Scholar
- 28.Seehusen DA, Johnson DR, Earwood JS, et al. Improving women’s experience during speculum examinations at routine gynaecological visits: randomized clinical trial. BMJ doi: 10.1136/bmj.38888.588519.55
- 31.Ferreyra S, Hughes K. Table Manners: A Guide to the Pelvic Examination for Disabled Women and Health Care Providers. San Francisco, CA: Sex Education for Disabled People, Planned Parenthood Alameda/San Francisco; 1984 (http://www.bhawd.org/sitefiles/TblMrs/cover.html (accessed 11/29/09).
- 35.http://www.thinprep.com/hcp/utilities/common_technical_questions.html accessed 11/14/10)
- 42.Potter J, Huang G. Web-Based Video Tutorials of the Pelvic Examination [website]. MedEdPORTAL; 2005. Available at: http://www.aamc.org/mededportal, ID = 142.
- 43.American College of Physicians. The Pelvic Examination: A Patient-Centered Approach Clinical Skills Series DVDGoogle Scholar
- 56.Makadon H, Mayer K, Potter J, Goldhammer H, eds. The Fenway Guide to Lesbian, Gay, Bisexual and Transgender Health. Philadelphia; American College of Physicians: 2007.Google Scholar
- 57.Feldman J. Medical and surgical management of the transgender patient: what the primary care clinician needs to know. In: Makadon H, Mayer K, Potter J, Goldhammer H, eds. The Fenway Guide to Lesbian, Gay, Bisexual and Transgender Health. Philadelphia: American College of Physicians; 2007:365–92.Google Scholar
- 62.Women with Disabilities Education Task Force. Women with Disabilities Education Program: Communication Modules 2008. http://www.womenwithdisabilities.org. accessed 11/29/09.
- 63.Reproductive Care for Women with Disabilities: An interactive site for clinicians serving women with disabilities. American College of Obstetrics and Gynecology. http://www.acog.org/departments/dept_notice.cfm?recno=38&bulletin=4526 accessed 10/14/10.
- 70.Nour NM. Female circumcision and genital mutilation: a practical and sensitive approach. Contemp Ob Gyn. 2000;45:50–5.Google Scholar