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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 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.
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383 news items

Oncology Nurse Advisor

Oncology Nurse Advisor
Thu, 02 Apr 2015 11:00:00 -0700

A recent study examined the accuracy of the bimanual pelvic examination in identifying ovarian cancer. The examination is performed during a routine pelvic examination and allows doctors to potentially detect abnormalities occurring in a woman's cervix.
 
The Inquirer
Wed, 22 Apr 2015 02:33:45 -0700

Meanwhile, medical examination of the victim included the conduct of a pelvic examination and a medical certificate was issued while medical and psychosocial care was administered. According to information gathered, the alleged perpetrator has gone ...
 
Fredericksburg.com
Sat, 28 Mar 2015 20:56:15 -0700

Now the ACP recommends against performing screening pelvic examination in asymptomatic, non-pregnant adult women. Just to clarify, we're not talking about Pap smears to screen for cervical cancer (though the latest guidelines for Pap smears by bodies ...
 
OurWindsor.ca
Tue, 14 Apr 2015 19:58:08 -0700

She also claimed he touched her clitoris and repeatedly inserted his finger in and out of her vagina in a sexual manner during a pelvic examination years after she had given birth. Karkanis, who denied all the allegations, appealed the committee's ...
 
Digital Journal
Mon, 20 Apr 2015 16:37:30 -0700

Other tests recommended by Obstetrician Crows Nest will include a pelvic examination and Pap smear. Other than this, this is the right time when the doctor will calculate the approximate due date. Prenatal examinations have relatively more ...
 
JAMA_ The Journal of the American Medical Association
Sat, 19 Jul 2014 08:13:22 -0700

Most women are accustomed to the uncomfortable ritual of having a yearly pelvic examination. But a new guideline from the American College of Physicians (ACP) suggests it may be time to make the procedure a thing of the past for women without any ...

SavingAdvice.com

MedPage Today
Mon, 30 Jun 2014 15:31:04 -0700

"Those women clearly need a pelvic examination, and that's fine." "Our guidelines talk about screening of asymptomatic women who are not pregnant. Those women simply don't need the exam. It's not something that is useful for them." The guideline also ...

Medscape

Medscape
Wed, 02 Jul 2014 09:09:31 -0700

The American College of Physicians (ACP) has issued new clinical guidelines recommending against screening pelvic examination in asymptomatic, nonpregnant, adult women. The college describes the recommendation as strong, with moderate-quality ...
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