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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.

418 news items

Baltimore Sun

Baltimore Sun
Wed, 24 Jun 2015 11:40:05 -0700

Dando was indicted in May 2014 based on a woman's allegations that he inappropriately touched her during an unchaperoned pelvic examination. Those charges were dropped a day before Dando was to stand trial, after he agreed to give up his medical ...

Jamaica Observer

Jamaica Observer
Mon, 22 Jun 2015 06:18:45 -0700

You need to consult your doctor and have a pelvic examination, Pap smear and ultrasound done. If there is evidence of an infection then this should be treated promptly. Your sexual partner should also be treated to reduce the risk of recurrence. A ...

GMA News

GMA News
Thu, 25 Jun 2015 02:00:00 -0700

A pelvic examination will then be done: a bivalve speculum (a small steel instrument) will be inserted into the vagina to look at the cervix. A normal cervix is smooth and clean, and any abrasions or abnormal growths will be noted. Many times, a small ...
 
Courthouse News Service
Mon, 22 Jun 2015 15:16:32 -0700

"The weight of the record evidence indicates that a pelvic examination prior to administering the mifepristone does not provide any measurable gain in patient safety," the decision states. "It is difficult to avoid the conclusion that the Board's ...

Doctor Tipster

Doctor Tipster
Thu, 18 Jun 2015 13:15:00 -0700

Uterine fibroid growths are common forms of benign tumors in the womb. The condition is present between 20% and 80% of women who reach the age of 40 and 50. The condition is relatively silent as it does not produce symptoms. They usually cause pain ...

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.

CBS Local

CBS Local
Mon, 08 Jun 2015 03:00:09 -0700

A nurse specializing in sexual assault also detailed the injuries the woman received and her efforts to recover DNA samples after the attack. The nurse said the victim was in tears during a pelvic examination, and also had a bloody nose, grass in her ...

IBNLive

The Hindu
Mon, 08 Jun 2015 00:41:15 -0700

The circular noted that “To do away with this essential pelvic examination would amount to incomplete assessment of the survivor, which will ultimately result in injustice and low conviction rates.” But it had also added that “informed consent” of the ...
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