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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 or 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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571 news items

Herald Sun

Herald Sun
Tue, 16 Dec 2014 00:15:02 -0800

The bank said it didn't request or require Ms Bashour to undertake a pelvic examination as part of an assessment but rather asked her to undertake “an independent consultation to assess the approp-riateness of the support measures offered by the bank, ...
 
AAFP News
Fri, 19 Dec 2014 11:07:30 -0800

Currently, Medicare covers a screening pelvic examination and Pap test for all beneficiaries at 12- to 24-month intervals depending on specific risk factors. Current coverage does not include HPV testing, even though HPV is associated with most cases ...
 
GMA News
Mon, 15 Dec 2014 02:52:30 -0800

Lola Marcia, a 75-year-old former piano teacher, came to see me because she was bothered by “something coming out of her vagina.” The problem started about 5 years ago when she noted vague, lower abdominal fullness and discomfort every time she ...

Cambridge News

Cambridge News
Tue, 16 Dec 2014 00:32:54 -0800

Meanwhile, women can opt for a breast examination and guidance on self-examination, a pelvic examination or cervical smear. "If you have a full understanding of your current health you can then tailor your lifestyle accordingly to live life to the full ...

NEWS.com.au

NEWS.com.au
Tue, 16 Dec 2014 10:19:53 -0800

A FORMER ANZ employee allegedly threatened with the sack because she declined a company-appointed pelvic examination while pregnant claims the drama forced her to give birth prematurely. Tragic ... A Pakistani man comforts a student standing at the ...

HCPLive

HCPLive
Tue, 30 Sep 2014 08:00:00 -0700

“Beauty is in the eyes of the beholder” and “seeing the same glass as being half-empty or half-full” are two commonly cited adages and nowhere is their meaning more evident than in the ongoing debate of whether a pelvic examination should be part of ...
 
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 ...
 
MLive.com
Fri, 28 Nov 2014 10:33:34 -0800

During a woman's pelvic examination, her physician removes cervical cells. A laboratory later checks the cells for pre-cancerous cells and viruses, such as the human papillomavirus (HPV). Women should undergo Pap smears every three years starting at ...
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