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Line drawing showing palpation in pelvic exam.
Broadly, it can be divided into the external examination and internal examination.
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.
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.
- examination of anatomy
- skin lesion
- palpation of stomach area
Use of a speculum 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.
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.
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. 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, though the original impetus for the study of pelvic exams and consent was an incident in 2007.
- "Examination of the Female Pelvis". Retrieved 2007-12-09.
- 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]
- ACOG Practice Advisory on Annual Pelvic Examination Recommendations June 30, 2014
- "Pelvic exam - MayoClinic.com". Retrieved 2007-12-09.
- "Time to end pelvic exams done without consent". The Globe and Mail (Toronto). 2012-09-06.[dead link]