Pelvic examination
A pelvic examination is a medical procedure that involves a visual inspection of the external female genitalia and the internal reproductive organs, typically including the cervix, uterus, and ovaries. This examination is crucial for women's health, as it allows healthcare providers to screen for various conditions, including cancers such as cervical, vulvar, and vaginal cancer. The process may include the collection of specimens for Pap tests and testing for infections like gonorrhea and chlamydia.
Patients are encouraged to prepare by abstaining from certain activities, such as using intravaginal products or engaging in sexual intercourse, prior to the exam. While the procedure can cause discomfort or embarrassment, especially for those with past trauma or specific gynecological issues, healthcare providers can offer ways to minimize discomfort. The outcomes of a pelvic examination can provide essential insights into a patient's reproductive health and are an important aspect of routine gynecological care.
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Pelvic examination
A pelvic examination is a visual inspection of external female genitalia, followed by insertion of a speculum into the vagina to visualize the cervix and a bimanual examination of the uterus and adnexa (ovaries, Fallopian tubes, and uterine ligaments) for masses, tenderness, and overall impression. It is also known as a female gynecological examination or reproductive health examination.
Cancers diagnosed: If a collection of cells for a Pap (Papanicolaou) test is done as part of the pelvic examination, then screening for cervical cancer and precursor cellular changes (precancerous conditions) is included. Visual inspection of the external genitalia may reveal abnormal tissue to be biopsied for the detection of vulvar or vaginal cancer. Pelvic examinations may also be beneficial in the detection of uterine cancers.
Why performed: A pelvic examination allows for the examination of internal and external genitalia, as well as the collection of specimens. Some pelvic examinations include laboratory specimen collection for Pap testing (with the collection of cervical and endocervical samples either by fixed slides or the liquid cytologic methodology); examination of vaginal discharge for bacterial vaginosis, trichomonas, or yeast vaginitis; and testing for common infections such as gonorrhea and chlamydia. Any particular pelvic examination, however, may include only some or none of these tests. Not all pelvic examinations include Pap testing. Exams may be performed for routine screening, including a Pap smear, for symptomatic gynecologic problems, or for medical training purposes.
Patient preparation: The patient should stop the use of any intravaginal creams or spermicides forty-eight hours ahead. Some providers may prefer for patients to refrain from heterosexual sexual intercourse for at least twenty-four hours beforehand as well. Douching should not be done before the exam. It is preferable for patients not to be menstruating when examined, although this may not be possible depending on the reason for the visit. Grooming is also not necessary. However, the patient's bladder should be emptied before the exam.
Patients should have a chance to express any concerns or apprehensions ahead of time and be given the opportunity to provide written informed consent if they are to have a pelvic exam while under anesthesia for another procedure. Patients may request a chaperone be present in the room during the procedure, and they may also decline the presence of additional staff.
Steps of the procedure: A pelvic exam involves the external examination and palpation of the genitalia with clean, gloved hands. This is followed by the insertion of a vaginal speculum, collection of specimens, and a bimanual examination with palpation of uterine and adnexal size, mobility, position, contours, presence of masses, and tenderness with palpation.
After the procedure: The medical provider will help the patient sit up slowly when the exam is completed.
Risks: Pelvic examinations may be embarrassing and emotionally and physically uncomfortable for some patients; it can be particularly difficult for those who have experienced sexual trauma and those with certain gynecological conditions.
Typically, the main physical discomfort is pressure. There should be no severe pain. Lying down at the far end of the table can relieve some pressure from the speculum, as can the use of a glove over the speculum. Different-sized speculums, lubrication, and deep breathing can help prevent or alleviate discomfort. Bleeding is possible following a pelvic examination, but it is not a cause for alarm unless excessive or prolonged.
Results: The results of a pelvic examination depend on visual examination and any clinical or laboratory findings. Pelvic examination remains one of the least invasive and most reliable methods of detecting possible cancers early and allowing for more thorough exploration of symptoms.
Bibliography
Bender, Rachel Grumman. “Why Are Pelvic Exams so Uncomfortable? And Why Hasn’t the Speculum Been Updated in 170 Years? Ob-Gyns Explain.” Yahoo Life, 18 Jan. 2023, www.yahoo.com/lifestyle/pelvic-exams-uncomfortable-speculum-175304720.html. Accessed 5 Apr. 2024.
Bose, Devna. “Hospitals Must Obtain Written Consent for Pelvic and Similar Exams, the Federal Government Says.” AP News, Apr. 2024, apnews.com/article/pelvic-exams-consent-federal-government-hhs-52331c180249daa1aa12c470f8d70061. Accessed 4 Apr. 2024.
Elit, Laurie. Cervical Cancer: Screening Methods, Risk Factors and Treatment Options. Nova Biomedical, 2014.
Gallardo, Adriana, and Jessica Miller. “Concerned about Your OB-GYN Visit? A Guide to What Should Happen — and What Shouldn’t.” The Salt Lake Tribune, 15 Sept. 2023, www.sltrib.com/news/health/2023/09/15/concerned-about-your-ob-gyn-visit/. Accessed 5 Apr. 2024.
Lalwani, Neeraj, and Theodore J. Dubinsky. Female Pelvic Imaging. Elsevier, 2013.
Leyendecker, John R., et al. Practical Guide to Abdominal and Pelvic MRI. 2nd ed., Philadelphia: Wolters Kluwer, 2011.
“Pelvic Exam.” Canadian Cancer Society, cancer.ca/en/treatments/tests-and-procedures/pelvic-exam. Accessed 20 June 2024.
Rocker, I. Pelvic Pain in Women: Diagnosis and Management. Springer, 1990.
Schneider, Karen M., and Stephen K. Patrick. Obstetrics and Gynecology: Pretest Self-Assessment and Review. McGraw, 2012.
Wilson, Jillian. “The 1 Thing Gynecologists Would Never Do before a Pap Smear.” Yahoo News, 24 July 2023, news.yahoo.com/1-thing-gynecologists-never-pap-094500364.html. Accessed 5 Apr. 2024.