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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.
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21 news items

Medscape

Huffington Post
Wed, 20 Aug 2014 15:30:00 -0700

Most women do not relish the thought of receiving a routine pelvic examination at their annual "well-woman" visit. Now, the American College of Physicians (ACP) has issued a controversial new guideline recommending against performing the annual pelvic ...

The Age

The Age
Thu, 07 Aug 2014 07:11:16 -0700

A heavily pregnant bank worker was threatened with disciplinary action because she would not undergo a pelvic examination by a company-appointed gynaecologist, a court has heard. Katherine Bashour, an ANZ employee of five years, went on early ...

Medscape

Medscape
Mon, 18 Aug 2014 09:18:45 -0700

Editor's Note: As defined by the American College of Obstetricians and Gynecologists (ACOG), a pelvic examination includes the external inspection of the genitalia urethra, vaginal, and anal region; a speculum exam of the vagina and cervix; and ...
 
Online Athens
Mon, 11 Aug 2014 13:29:13 -0700

I often emphasize to my patients the importance of a yearly pelvic examination which can help in detection of an enlarged ovary. It is also important to notify your doctor if you are experiencing any new symptom that has been persistent for several days.

Daily Life

Daily Life
Thu, 07 Aug 2014 16:26:15 -0700

The ANZ bank threatened a heavily pregnant worker with disciplinary action because she would't undergo a pelvic examination by a company-appointed gynaecologist. Katherine Bashour, an ANZ employee of five years, went on early maternity leave last ...
 
Baltimore Sun
Wed, 20 Aug 2014 10:03:45 -0700

MedExpress said it fired Dando after another woman told police that he inappropriately touched her during an unchaperoned pelvic examination at MedExpress, in LaVale, outside of Cumberland. Dando was indicted in May based on those accusations, ...

Daily Life

Daily Life
Sun, 10 Aug 2014 07:10:28 -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 has denied those claims and says they were only asking her to see a doctor in order to assist ...
 
GMA News
Sun, 17 Aug 2014 19:48:45 -0700

Pelvic examination showed that indeed her uterus was larger than the expected dates, and upon further questioning she recalled that she had an aunt and an uncle who were twins. Pelvic ultrasound clinched the diagnosis: She was carrying twins! Stunned ...
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