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Pelvic examination
Intervention
Pelvic exam nci-vol-1786-300.jpg
Line drawing showing palpation in pelvic exam.
ICD-9-CM 89.26
An image that shows the introitus (the opening of the vagina) in relation to its surrounding structures, when the labia are displaced by digits during a pelvic examination.

A pelvic examination, also pelvic exam, is a physical examination of the female pelvic organs.

Broadly, it can be divided into the external examination and internal examination.[1]

It is also called "Bimanual Exam" & "Manual Uterine Palpation".

In July 2014, the American College of Physicians (ACP) issued a guideline recommending against performing screening pelvic examination in asymptomatic, nonpregnant, adult women. (The guideline did not consider Pap smears.) The ACP said that there was no evidence of benefit in support of the examination, but there was evidence of harm, including distress and unnecessary surgery. This was a strong recommendation, based on moderate-quality evidence.[2]

The American College of Obstetricians and Gynecologists (ACOG) disagreed. While they acknowledged that a routine annual pelvic exam was not supported by scientific evidence, it was supported by clinical experiences of gynecologists treating their patients. Pelvic exams are an occasion for gynecologists to recognize issues like incontinence and sexual dysfunction, and discuss patient concerns generally, ACOG said.[3]

External examination[edit]

  • examination of anatomy
  • skin lesion
  • palpation of stomach area

Internal examination[edit]

Speculum exam[edit]

Use of a speculum[4] to locate the external cervical os. Examination for foreign bodies and cervical swabs are taken at this point in the exam. These swabs of the epithelium layer of the cervix are known as a Pap smear. Other vaginal swabs can be taken at this time or STI testing.

Bimanual exam[edit]

Two fingers are inserted into the vagina until they isolate the cervix. Then the health care professional tests for cervical motion tenderness, as classically seen in pelvic inflammatory disease. The examiner palpates the uterus, including location of the fundus of the uterus and the adnexal structures.

Discomfort[edit]

The exam should not be excessively uncomfortable, but a woman with a vaginal infection may feel pain when the speculum is inserted. During the bimanual exam, the palpating of the ovaries may be painful. The pap test may cause some cramping as well.

Informed consent[edit]

For educational purposes, trainee doctors have performed pelvic exams on unconscious women. The subjects are those undergoing surgery for unrelated causes, and they were rarely informed the examination had occurred. This practice was forbidden in the United States, New Zealand and the United Kingdom, which now require the patient to consent in advance. The practice still continues in Canada according to a study published in the Journal of Obstetrics and Gynecology.[5] The director of the Medical Health program at the University of Manitoba claimed in response that the revised 2006 guidelines of the Society of Obstetricians and Gynecologists of Canada forbade pelvic exams without consent,[6] though the original impetus for the study of pelvic exams and consent was an incident in 2007.[5]

See also[edit]

Well-woman examination

References[edit]

  1. ^ "Examination of the Female Pelvis". Retrieved 2007-12-09. 
  2. ^ Qaseem, A; Humphrey, LL; Harris, R; Starkey, M; Denberg, TD; Clinical Guidelines Committee of the American College of, Physicians (Jul 1, 2014). "Screening pelvic examination in adult women: a clinical practice guideline from the American College of Physicians.". Annals of internal medicine 161 (1): 67–72. doi:10.7326/M14-0701. PMID 24979451. [Free text]
  3. ^ ACOG Practice Advisory on Annual Pelvic Examination Recommendations June 30, 2014
  4. ^ "Pelvic exam - MayoClinic.com". Retrieved 2007-12-09. 
  5. ^ a b "Time to end pelvic exams done without consent". The Globe and Mail (Toronto). 2012-09-06. [dead link]
  6. ^ http://www.winnipegfreepress.com/life/health/Women-must-give-consent-for-pelvic-exam-MD-83085377.html

External links[edit]


Original courtesy of Wikipedia: http://en.wikipedia.org/wiki/Pelvic_examination — Please support Wikipedia.
This page uses Creative Commons Licensed content from Wikipedia. A portion of the proceeds from advertising on Digplanet goes to supporting Wikipedia.

21 news items

HCPLive

HCPLive
Tue, 30 Sep 2014 08:00:00 -0700

“Beauty is in the eyes of the beholder” and “seeing the same glass as being half-empty or half-full” are two commonly cited adages and nowhere is their meaning more evident than in the ongoing debate of whether a pelvic examination should be part of ...
 
News-Medical.net
Fri, 03 Oct 2014 00:05:59 -0700

Women who have a history of violent sexual abuse may suffer emotional distress during a routine pelvic examination. Healthcare providers would benefit from greater awareness of symptoms predictive of examination-related distress in this patient ...

Tallahassee.com

Tallahassee.com
Wed, 29 Oct 2014 13:15:00 -0700

About a week before that, a pelvic examination found no trauma to the woman and Assistant State Attorney Jack Campbell told prosecutors no evidence existed to prove a crime occurred. Campbell told investigators to wait on sexual assault kit results ...

Daily Life

Daily Life
Sun, 19 Oct 2014 20:40:34 -0700

The court heard she was threatened with disciplinary action because she would not undergo a pelvic examination by a company-appointed gynaecologist. The bank denied those claims at the time and said they were only asking her to see a doctor in order to ...

Youth Health Magzine

Youth Health Magzine
Fri, 24 Oct 2014 20:45:00 -0700

During one of her follow-up appointments for a pelvic examination, one of the women, who had been diagnosed with cancer, said that Shah asked her when her last breast examination was conducted. And, although she informed him that she was not there ...
 
AAP News (subscription)
Mon, 29 Sep 2014 04:15:00 -0700

Be aware that it is appropriate to prescribe contraceptives or refer for IUD placement without first conducting a pelvic examination. Screening for sexually transmitted infections (STIs), especially chlamydia, can be performed without a pelvic ...
 
Medscape
Tue, 30 Sep 2014 10:40:00 -0700

Long-acting reversible contraceptives (LARC) should be the first-line option for sexually active teenagers, according to a new guidelines on teenaged pregnancy prevention from the American Academy of Pediatrics (AAP). The updated policy statement and ...
 
Wicked Local Rochester
Mon, 08 Sep 2014 11:45:00 -0700

This column is seeing its third iteration this week. I first put it together in 2012 after being contacted by a woman who expressed her appreciation for our company "painting the paper pink" in October with stories about National Breast Cancer ...
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