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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.

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.[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 (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.[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 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.[5] 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,[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. Archived from the original on January 30, 2010. 
  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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586 news items

MassLive.com

MassLive.com
Tue, 02 Feb 2016 13:22:30 -0800

He described injuries that were recorded during a sexual assault pelvic examination as "very minimal." Also, while hospital staff have testified for the prosecution that the woman was intoxicated and at times could not be roused from sleep, Leibowitz ...

Doctors Lounge

Doctors Lounge
Tue, 02 Feb 2016 10:11:15 -0800

Obstetrician-gynecologists report commonly performing external and speculum examinations in asymptomatic older women, according to a study published online Jan. 25 in the Journal of the American Geriatrics Society.

Philly.com (blog)

Philly.com (blog)
Tue, 19 Jan 2016 06:00:53 -0800

In 1997, I had a routine yearly pelvic examination and had been asymptomatic. However, the gynecologist felt something abnormal, did an immediate pelvic ultrasound, and called his friend, a GYN oncologist in the same office suite, to come in immediately.
 
Sentry
Fri, 22 Jan 2016 07:00:00 -0800

A doctor will conduct a pelvic examination and feel the uterus and ovaries. Imaging tests, such as ultrasound and CT scans, can help determine if there are abnormalities in the ovaries. A blood test, which will detect the protein CA 125, can help to ...
 
Medgadget.com (blog)
Wed, 20 Jan 2016 09:26:15 -0800

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 ...

The Monitor Daily

The Monitor Daily
Sat, 16 Jan 2016 04:09:34 -0800

The Pap test is comprised of non-invasive pelvic examination and the collection of a cell sample for the cervix. Besides being the most common and efficient way of detecting cervical cancer, the Pap test can also detect infections in the endocervix and ...

ModernMedicine

ModernMedicine
Fri, 01 Aug 2014 11:10:03 -0700

The absence of evidence for benefit is not the same as evidence of absence of benefit. August 01, 2014. By Charles J. Lockwood, MD, MHCM. Dr. Lockwood, Editor-in-Chief, is Dean of the Morsani College of Medicine and Senior Vice President of USF Health ...

CBC.ca

CBC.ca
Mon, 05 Oct 2015 03:53:49 -0700

The decision says Wadden admitted to an "inappropriate pelvic examination" and misconduct. "This is an extremely serious matter," Dr. Gus Grant, CEO of the college, said in an interview with CBC News. "Dr. Wadden's professional record will permanently ...
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