How to Ensure Every Pelvic Exam Follows a Standard Process and Why It Matters
Pelvic exams are generally a quick, routine procedure that most sexually active women should get once a year. However, there are now different recommendations in place and some doctors perform them less frequently. Pelvic exams may also be performed if a woman is experiencing unusual spotting or vaginal discharge, pain during intercourse, during pregnancy, or as part of a fertility exam. Because pelvic exams are so routine, they follow a set pattern that providers should stick to.
Why Is It Important to Standardize Pelvic Exam Procedure?
There are a number of reasons why it is important to ensure that every pelvic exam follows a standard procedure:
Provider Completes Exam
It ensures that the provider performing the exam does not miss a step. Also, appropriate lube usage.
For the comfort of the patient, it is generally better to perform the PAP smear before the bi-manual exam. Using the speculum helps relax the vagina and makes it easier to insert fingers to examine and palpate the ovaries. Having a set procedure helps avoid inexperienced providers trying to do things the “wrong way around”.
Many patients are nervous, especially younger women who are getting their first pelvic exam or survivors of sexual assault. Having a set procedure makes it easier for the provider to explain what they are doing and what comes next.
It makes the procedure go faster, which saves time for discussion and helps providers avoid running late and inconveniencing subsequent patients. A routine makes completion quicker. In many cases, abnormalities that are found (except for PAP smear results) need to be discussed right away, and it is better to allow extra time for that.
Avoids Sexual Misconduct
Having a set procedure helps avoid accusations of sexual misconduct against doctors. Doctors should avoid any physical contact that is not strictly necessary to get results.
As a pelvic exam is generally part of an annual well-woman exam, it helps keep the entire thing smooth if there is a standardized order for the examination as a whole.
The Correct Order
In general, the order the provider should follow is:
- External inspection of the vulva and genital area.
- Examination with the speculum and PAP smear. In some cases, a PAP smear may not be taken every time, but the speculum is still used to allow visual inspection of the vagina and cervix. This is particularly important for women on hormonal birth control or women who have a history of abnormal PAP smears.
- Bimanual exam to check the ovaries, uterus, and bladder for abnormalities.
- Rectal exam of needed.
If a urine sample is needed, it should be taken before the exam. The order should not be changed even if the patient has issues, although more time should be allowed for women who have a history of sexual assault, first-time patients, and patients who have experienced unusual levels of discomfort during prior exams. It is vital for the provider to be willing to slow down or stop if the patient is experiencing pain or mental distress.
What Is the Best Way to Ensure Procedures are Followed?
Another key element is to set out the equipment in the appropriate order. This may be done on the same table as other equipment needed for an annual wellness exam. It is often faster to have a physician assistant do this. Although, this opens up the risk of the person doing this wrong. Everything should be set out by the provider. The provider should always make sure there is a smaller sized speculum available and that there is enough lube.
However, having an assistant set out the equipment before the patient is even in the examination room saves time.
Pelvic Exam Kit
One ideal way to ensure that routine procedure is followed is to use a set pelvic exam kit that contains all the things needed. A pelvic exam kit should include This should include non-latex gloves (latex should be avoided due to the prevalence of allergies), a single-use speculum, specimen tube, and cap. By having everything in one kit, you ensure that none of the needed items are forgotten or not in the exam room. This prevents the need to search for, say, the right kind of swabs, delaying the patient’s appointment and frustrating providers.
Why the Kit Is Important
Easily set the kit on the table. Although, it is still important to get items in the right order to allow for a quick and smooth process. Using a kit helps to ensure:
- All needed items are in the examination room.
- Needed items can be set out quickly and in the proper order, reducing turnover between patients.
- The provider, especially if less experienced, remembers the order to do the exam, as the equipment can provide appropriate visual cues. This means no missed steps and the procedure minimizes patient discomfort and anxiety.
- After the procedure, dispose of single-use items are properly. The entire kit, as a unit, can be disposed of.
Learn More About a Pelvic Exam
obp’s vaginal exam kits contain our single-use speculums with integrated light sources. These are ideal for quick use and preventing cross-contamination between patients. To find out more about our kits and request a sample for your office, contact obp today.