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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.
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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409 news items

Norwich Bulletin

Norwich Bulletin
Thu, 28 May 2015 19:26:15 -0700

Saxena asked the woman if she ever had a breast or a pelvic examination, she told police. When she replied she hadn't, she said he made several inappropriate remarks, according to police. The woman told police Saxena told her to pull up her shirt and ...

Oncology Nurse Advisor

Oncology Nurse Advisor
Wed, 27 May 2015 13:48:45 -0700

All organizations recommend against pelvic examination, cancer antigen 125 blood tests, and transvaginal ultrasonography for ovarian cancer screening. No organization recommends prostate-specific antigen testing unless benefits and harms are discussed ...

Newsworks.org

Newsworks.org
Sun, 24 May 2015 02:00:00 -0700

Thomas Jefferson University gynecologic oncologist Norman Rosenblum said he agreed with most of the recommendations, but not the idea that pelvic exams should go by the wayside. "I think every woman should have a yearly pelvic examination and have ...

Closer

Closer
Tue, 26 May 2015 06:52:30 -0700

A vaginal or pelvic examination (similar to a cervical screening test) may be carried out to work out where the bleeding is coming from. You may also be asked for a urine and / or blood sample, to help to determine your pregnancy hormone levels. Most ...
 
Doctors Lounge
Wed, 20 May 2015 09:30:00 -0700

All organizations recommend against pelvic examination, cancer antigen 125 blood tests, and transvaginal ultrasonography for ovarian cancer screening. No organization recommends prostate-specific antigen testing unless benefits and harms are discussed ...

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.
 
Daily Union
Tue, 05 May 2015 07:49:14 -0700

A pelvic examination of the X-Ray enabled officials to identify that the remains were the body as that of a female, Parker said, adding that there was no indication, based on the initial analysis completed, to determine the individual's race. FOX-6 ...
 
Ob.Gyn. News Digital Network
Tue, 05 May 2015 21:16:49 -0700

Fewer said a Pap smear is the same as a pelvic examination (43% vs. 74%), is a test for a sexually transmitted disease (24% vs. 56%), is a pregnancy test (17% vs. 36%), or is a checkup (20% vs. 53%). In a video interview, Dr. Howard discussed his ...
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