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Pelvic examination
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.


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


  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.

1813 news items


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 ...
EurekAlert (press release)
Mon, 05 Oct 2015 14:00:00 -0700

The evidence showed that the diagnostic accuracy of the screening pelvic examination for detecting ovarian cancer or bacterial vaginosis is low; the test rarely detects noncervical cancer or other treatable conditions; and was not associated with ...


Sat, 03 Oct 2015 16:05:16 -0700

“The violation took place in the course of an unchaperoned pap smear and involved an inappropriate pelvic examination,” the college wrote in the decision. Wadden is allowed to serve his suspension in two intervals of three months each. It must be ...

Fort Wayne Journal Gazette

Fort Wayne Journal Gazette
Sat, 26 Sep 2015 22:03:45 -0700

... Patient Educators, remembers trying to spread the word at an American College of Physicians conference in the '90s, blocking off space with a velvet curtain and asking passing doctors, “Would you like to refine your breast and pelvic examination ...
Fri, 11 Sep 2015 03:18:45 -0700

Dr Brown told Medscape Medical News that three areas warrant special attention from clinicians: the recommendations on breast screening, pelvic examination, and screening for depression and for domestic violence. The recommendations are based on age ...
Times Herald-Record
Thu, 17 Sep 2015 15:07:30 -0700

... at tealwalk.org, cancer.org or the Orange County-based corinnefeller.org, say this: If you have symptoms like persistent abdominal pain, you should ask your doctor for a CA-125 blood test, a transvaginal ultrasound and a vaginal-rectal pelvic ...


Wed, 16 Sep 2015 11:24:51 -0700

Some of the new Life/form® highly specialized skills trainers in this year's catalog include the Advanced Injection Belly, Advanced Pelvic Examination and Gynecological Simulator, and the Cricothyrotomy Simultor. The catalog also features hundreds of ...

Medgadget.com (blog)

Medgadget.com (blog)
Mon, 21 Sep 2015 21:49:41 -0700

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 ...

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