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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 for 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 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]

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 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.[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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406 news items

 
Medscape
Fri, 31 Jul 2015 02:11:15 -0700

"Chlamydia screening needs to be unlinked from the pelvic examination and cervical cancer screening," the authors write. "The American College of Physicians recently recommended against performing a screening pelvic examination in nonpregnant, ...

Florida Times-Union

Florida Times-Union
Tue, 14 Jul 2015 12:33:34 -0700

Some may not think it's necessary, or may want to prevent them from having a pelvic examination. In many cases, the mother's OB/GYN will offer to see the patient's daughter for her first visit, but he or she might not be well suited for a pediatric or ...
 
ModernHealthcare.com
Thu, 09 Jul 2015 16:33:24 -0700

Before the decision, Medicare covered a screening pelvic examination and Pap test for women at 12- or 24-month intervals but did not cover HPV testing. The scope of the new decision is limited to screening for cervical cancer, along with HPV testing.
 
California Healthline
Fri, 10 Jul 2015 08:04:57 -0700

Cervical cancer tends to occur in midlife and most cases are discovered in women under age 50. Medicare had covered a pelvic examination and Pap test for all female beneficiaries at 12- or 24-month intervals, though it did not cover HPV testing.
 
Nursing in Practice
Thu, 23 Jul 2015 07:37:30 -0700

Currently there are no non-invasive tests with a clinically relevant degree of sensitivity. A pelvic examination is usually only useful for assessing the presence of large endometriotic ovarian cysts (endometrioma), palpable nodules on the uterosacral ...

ZNBC

ZNBC
Mon, 20 Jul 2015 00:18:45 -0700

... Cancer Prevention Programme at the Ministry said there is still need for increased information dissemination about cancer. Dr Kapambwe said people in certain rural locations have no idea what cancer is while women only get to have a pelvic ...
 
Medgadget.com (blog)
Wed, 08 Jul 2015 12:41:36 -0700

Ovarian cancer is diagnosed with the help of pelvic examination, blood test, ultrasound and other tests such as MRI, PET and CT. Lack of early warning symptoms and early diagnostic tests for detection are the major causes of high rate of death due to ...
 
Medgadget.com (blog)
Thu, 16 Jul 2015 15:13:22 -0700

The U.S. Department of Health and Human Service recommend pelvic examination on an annual basis which also increases the growth prospects of this market. In 2013, the total number of new cases of gonorrhea diagnosed in genitourinary medicine (GUM) ...
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