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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 a gloved finger.

A pelvic examination, also known as a pelvic exam or vaginal 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" (i.e. using two hands) & "Manual Uterine Palpation" (palpation meaning an examination by touch). It is frequently used in gynecology.

External examination[edit]

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

Internal examination[edit]

Speculum exam[edit]

A speculum exam showing the ectocervix of a postmenarchal, nulliparous woman.

Use of a speculum[2] 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 to test for sexually transmitted diseases.

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 presses down on the abdomen with the external hand, to locate 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 or vaginismus may feel pain when the speculum is inserted. Using the smallest available speculum may help. During the bimanual exam, the palpating of the ovaries may be painful. The pap smear may cause some cramping as well.

Informed consent[edit]

Main article: Informed consent

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.[citation needed] This practice is 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.[3] A spokeswoman for the University of Manitoba College of Medicine claimed in 2010 that the revised 2006 guidelines of the Society of Obstetricians and Gynaecologists of Canada forbade pelvic exams without consent,[4] though the original impetus for the study of pelvic exams and consent was an incident in 2007.[3]

American guidelines[edit]

In July 2014, the American College of Physicians (ACP) issued a guideline recommending against performing this examination to screen for conditions 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.[5]

The American College of Obstetricians and Gynecologists (ACOG) disagreed. While they acknowledged that a routine annual pelvic exam was not supported by scientific evidence (see Evidence-based medicine), 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.[6]

See also[edit]

Well-woman examination

References[edit]

  1. ^ "Examination of the Female Pelvis". Retrieved 2007-12-09. 
  2. ^ "Pelvic exam - MayoClinic.com". Retrieved 2007-12-09. 
  3. ^ a b "Time to end pelvic exams done without consent". The Globe and Mail (Toronto). 2012-09-06. Archived from the original on January 30, 2010. 
  4. ^ http://www.winnipegfreepress.com/life/health/Women-must-give-consent-for-pelvic-exam-MD-83085377.html
  5. ^ 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]
  6. ^ ACOG Practice Advisory on Annual Pelvic Examination Recommendations June 30, 2014

External links[edit]


Original courtesy of Wikipedia: http://en.wikipedia.org/wiki/Pelvic_examination — Please support Wikipedia.
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677 news items

 
Medscape
Wed, 30 Mar 2016 21:07:30 -0700

The pelvic examination includes three components: inspection of the external genitalia (vulva, urethral meatus, vaginal introitus, perianal region); speculum examination of the vagina and cervix; and bimanual examination of the uterus, cervix, and adnexa.

Elko Daily Free Press

Elko Daily Free Press
Thu, 21 Apr 2016 00:30:00 -0700

DEAR DOCTOR K: I'm a woman in my 50s, and every so often it is painful for several days when I urinate. The doctor tests me, says I don't have a urinary tract infection, and that there's nothing to do. It's true that it goes away, but I'd like some ...

Medgadget.com (blog)

Medgadget.com (blog)
Tue, 26 Apr 2016 01:18:39 -0700

Physical examination, medical history, blood tests, pelvic examination and vaginal ultrasound helps in diagnosis of polycystic ovarian syndrome. Early diagnosis and treatment can help to control the symptoms and prevent long term complications. Some of ...

6minutes

6minutes
Tue, 26 Apr 2016 00:50:40 -0700

Having graduated and done my obs/gynae before the days of easy availability of ultrasound scans we assessed early gestation by pelvic examination - now I have my own scanner but still like to correlate ultrasound findings with uterine size. What about ...

6minutes

6minutes
Tue, 26 Apr 2016 00:52:30 -0700

Having graduated and done my obs/gynae before the days of easy availability of ultrasound scans we assessed early gestation by pelvic examination - now I have my own scanner but still like to correlate ultrasound findings with uterine size. What about ...
 
Journal of Ultrasound in Medicine (subscription)
Wed, 30 Mar 2016 14:33:45 -0700

Agreement for parametrial infiltration between MRI and pelvic examination was fair (κ = 0.26; 95% confidence interval [CI], 0.10–0.54; 62.5% agreement), between MRI and 2D sonography was moderate (κ = 0.41; 95% CI, 0.15–0.66; 70.0% agreement), and ...

Herald Sun

Herald Sun
Wed, 30 Mar 2016 21:28:01 -0700

There's the cost of a pelvic examination for starters, not to mention the “mermaids” at the city baths. It's just that she tells these stories in such a self-deprecating and vulnerable way that her anecdotes are more likely to elicit a giggle rather ...
 
TheSequitur.com
Tue, 19 Apr 2016 05:33:45 -0700

The exams you will take will not be related to fertility testing, but it will be a pelvic examination which will determine whether you are ready for this step or not. If after the test, the specialist will decide that there is nothing wrong with your ...
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