Pelvic Exams: Uncomfortable but Necessary for Female Patients
Annual medical checkups are critical to helping women maintain optimal physical health. The American College of Obstetricians and Gynecologists call these well-woman visits.
These appointments give doctors an opportunity to speak with patients about minimizing medical risks. The physicians tell women about preventive services and screenings. They perform routine screenings to catch cancers and sexually transmitted diseases at an earlier stage. Doctors also gather patients’ medical history to provide advice that aligns with patients’ desired health goals.
The cornerstone screening for most well-woman visits is the pelvic exam. On average, physicians complete 60 million pelvic exams every year. Unfortunately, many women complain that the metal speculums used during pelvic examination feel uncomfortable.
In today’s obp guide, doctors will learn how to make the pelvic exam process more comfortable for patients.
What is a Pelvic Exam?
Pelvic exams are routine medical screenings of a woman’s internal and external reproductive organs. They help doctors evaluate the causes of bleeding, pain, and vaginal discharge. Gynecologists use two hands to perform a manual uterine palpitation of the vagina, cervix, ovaries, fallopian tubes, and uterus.
The medical checkup only lasts a few minutes. Physicians look for abnormalities in the rectum and pelvis. They conduct a Pap test to screen for cervical cancer.
Most physicians don’t pay attention to the mechanics of a pelvic exam. They don’t worry about whether their patients feel comfortable during the process. A 2011 Beth Israel Medical Deaconess Center study discovered that many women believe the procedure is intrusive and uncomfortable. Women become anxious about the process. Patients also feel they have no control during the exam.
Their emotional distress and fear of pain lead women to avoid pelvic exams. Patients who avoid them are adolescents, disabled women, obese persons, and rape and sexual trauma victims. Most women will have their first pelvic examination at 21 years old.
Why Do Doctors Conduct Pelvic Exams?
Pelvic exams are necessary for two reasons.
- Assessing Gynecological Health – During the examination, the gynecologist will screen the pelvic area for ovarian cysts, early-stage cancers, sexually transmitted diseases, and uterine fibroids. Doctors also use them to monitor pregnant women’s health. Experts don’t agree about how often patients should get pelvic exams.
- Diagnosing Medical Conditions – A physician may recommend the examination when a woman has unusual symptoms such as bleeding, pelvic pain, abnormal vaginal discharges, urinary problems, and skin changes. The screening can help a physician diagnose any potential issues.
Helping Patients Before the Exam
A National Institutes of Health Study called “The Challenging Pelvic Examination,” said maximizing comfort should be the goal of during pelvic examinations. The study’s authors found that proper lubrication, careful speculation, and instrument insertion could ease the intrusive process for patients.
Some women can feel anxious about pelvic examination for several reasons.
- Patients are receiving their first pelvic exam.
- Individuals had prior experience of trauma.
Pelvic exams should only last a few minutes. They should not be uncomfortable or painful. Patients are advised to do the following during a pelvic examination to make it more comfortable.
Doctors should speak to patients about the reason for the pelvic examination. Before the procedure, women should void any urine. Full bladders can cause extreme discomfort during a bimanual exam. It can also prevent the physician from palpating organs. This step also prevents urinary leakage in older women that have a loss of pelvic floor tone.
They should allow them to examine the speculum, if possible, although this may not ease their anxiety.
- Breathe deeply and slowly.
- Relax your abdominal muscles, shoulders, and thigh muscles until they soften.
- Ask your physician to describe what’s happening.
- Chaperones must accompany physicians during the pelvic examination.
- Don’t Use Sexual Innuendos – Next, doctors should limit and avoid any sexual language to maximize patient comfort. Positioning on the table should be accomplished with verbal clues. Doctors should only provide patients with assistance if they request it. The torso and legs should be kept draped to protect the patient’s modesty.
- Alert Patients Before Using Instruments – Additionally, they should tell patients that cytology (Pap Test) sampling can cause short-term cervical bleeding and spotting.
- Preserve Modesty – Use statements to position patients on tables. Don’t touch them, unless a patient asks for help. Clinicians prefer the lithotomy pose to conduct vaginal exams. Some patients describe this position as humiliating. These women also find the stirrups used to support their feet as uncomfortable and cold. Physicians can use alternate positions like the V position (supine, hips abducted, knees extended) and padded stirrups for patients.
- Speculum Selection – As a general rule, wider speculums cause more patient discomfort. Doctors should select the most narrow speculum that allows them to examine the cervix. Always check speculums before use to ensure that they function correctly.
- Use Single-Use Speculums to Prevent Cross-Contamination – obp’s ER-SPEC is ready to use without any additional parts or assembly required. It is the first the single-use speculum that eliminates processing expenses. Additionally, the speculum reduces the risk of contamination. obp offers the speculum extra-small through extra-large sizes. It has an LED light source powered by low-voltage alkaline button batteries. For details, visit this page.
Completing the Pelvic Exam
Physicians give patients some privacy to undress and change into a gown before the exam. Afterward, women receive a sheet to cloak their waists to keep them warm. First, the physician checks the abdomen, then completes a routine breast cancer screening. Next, they listen to the heart and lungs.
Gynecologists typically explain the medical procedure before the pelvic exam begins. The medical examination has several parts.
1. External Visual Exam
Doctors examine the vulva for sores, redness, and irritation. They will also check the area and vaginal opening for abnormal discharge, genital warts, and cysts. These signs could indicate cancer or sexually transmitted diseases. Vulvar pathologies may include psoriasis, vulvar vestibulitis, and neoplasia.
2. The Speculum Exam (Internal Examination)
Doctors use a duck-billed instrument called a speculum. This tool helps gynecologists to spread apart the vaginal walls. Speculums come in two varieties: metal and plastic. After opening the vaginal area, the gynecologists can examine the cervix. Sometimes, using the speculum can be uncomfortable, since they exert some pressure. Doctors may warm metal speculums to help patients feel comfortable. Plastic, single-use speculums, like obp’s ER-SPEC, are ready to use. They don’t require warming before insertion. Physicians tell their patients to relax so they won’t feel any discomfort.
3. Pap Tests (Cervical Cytology)
Patients can ask their physician for a mirror to view their cervix. Gynecologists will use a spatula to collect cervical cells to screen for pre-cancerous changes. This screening is the Pap Test. The American College of Obstetricians and Gynecologists (ACOG) recommend that asymptomatic, healthy women receive cytology tests every three years.
4. STD Exam
Physicians will also test for suspected STDs like chlamydia or gonorrhea. They use a cotton swab to obtain a vaginal discharge sample from the cervix.
5. High-Risk HPV Testing
Doctors perform this screening to search for DNA and RNA types of the HPV virus (16 and 18). This pathogen may cause cellular changes that include cancer. ACOG recommends women receive this screening after the age of 30. They should get tested every five years.
6. Vaginal Exam (Bimanual Examination)
Physicians can’t see the pelvic organs with their naked eyes. They need to palpate the abdominal muscles to check the organs during this examination. A gynecologist will put on gloves. He or she will insert two lubricated fingers into the vagina. They press down on the lower abdomen with the second hand to check for three qualities:
- The uterus’s size, shape, and position
- Signs of infection (including tenderness and pain)
- Abnormalities in the organs (ovarian cysts, enlarged ovaries, fallopian tubes, and tumors).
7. Rectovaginal Exam
Some physicians place a gloved finger into the rectum to check the muscles between the anus and vagina. This screening helps physicians look for tumors along the lower vaginal walls and behind the uterus.
8. After the Exam
Physicians should ask the patient to dress following pelvic exams. They should discuss the result of your initial screening and any abnormalities found during the procedure.
Physicians can make pelvic exams more comfortable when they use the right tools. obp’s ER-SPEC is the premier single-use vaginal specula with an integrated light source. It is perfect for conducting routine pelvic exams and any procedure where gynecologists need to illuminate the vaginal cavity. For details about our product line, contact us today.