What position is used for a patient who is scheduled for a pelvic examination?

This Committee Opinion was developed by the American College of Obstetricians and Gynecologists’ Committee on Gynecologic Practice in collaboration with committee members Catherine Cansino, MD, MPH and Lubna Chohan, MD.

ABSTRACT: The pelvic examination has long been considered a fundamental component of the well-woman visit, and many women and gynecologic care providers view this visit as an opportunity to discuss sexual and reproductive health issues. Traditionally, a pelvic examination is performed for asymptomatic women as a screening tool for gynecologic cancer, infection, and asymptomatic pelvic inflammatory disease; some obstetrician–gynecologists and patients consider it important in detecting subclinical disease, despite evidence to the contrary. Given changes in screening recommendations and the ability to screen for sexually transmitted infections using less-invasive methods, reevaluation of the role of the pelvic examination for asymptomatic, nonpregnant women is warranted. A limited number of studies have evaluated the benefits and harms of a screening pelvic examination for detection of ovarian cancer, bacterial vaginosis, trichomoniasis, and genital herpes. Data from these studies are inadequate to support a recommendation for or against performing a routine screening pelvic examination among asymptomatic, nonpregnant women who are not at increased risk of any specific gynecologic condition. It is recommended by the American College of Obstetricians and Gynecologists that pelvic examinations be performed when indicated by medical history or symptoms. Women with current or a history of cervical dysplasia, gynecologic malignancy, or in utero diethylstilbestrol exposure should be screened and managed according to guidelines specific to those gynecologic conditions. Based on the current limited data on potential benefits and harms and expert opinion, the decision to perform a pelvic examination should be a shared decision between the patient and her obstetrician–gynecologist or other gynecologic care provider.

Recommendations and Conclusions

The American College of Obstetricians and Gynecologists (ACOG) makes the following recommendations and conclusions regarding the use of and indications for the pelvic examination:

• Pelvic examinations should be performed when indicated by medical history or symptoms.

• Based on the current limited data on potential benefits and harms and expert opinion, the decision to perform a pelvic examination should be a shared decision between the patient and her obstetrician–gynecologist or other gynecologic care provider.

• A limited number of studies have evaluated the benefits and harms of a screening pelvic examination for detection of ovarian cancer, bacterial vaginosis, trichomoniasis, and genital herpes. Data from these studies are inadequate to support a recommendation for or against performing a routine screening pelvic examination among asymptomatic, nonpregnant women who are not at increased risk of any specific gynecologic condition. Data on its effectiveness for screening for other gynecologic conditions are lacking.

• Women with current or a history of cervical dysplasia, gynecologic malignancy, or in utero diethylstilbestrol exposure should be screened and managed according to guidelines specific to those gynecologic conditions.

• After reviewing risks and benefits, the pelvic examination also may be performed if a woman expresses a preference for the examination.

• Regardless of whether a pelvic examination is performed, a woman should see her obstetrician–gynecologist at least once a year for well-woman care . A preventive service visit also provides an opportunity for the patient and her obstetrician–gynecologist to discuss whether a pelvic examination is appropriate for her. Screening for gynecologic cancer and STIs are common reasons physicians report performing a pelvic examination in asymptomatic, nonpregnant patients. However, studies show that pelvic examinations do not decrease ovarian cancer morbidity and mortality rates . A pelvic examination is not necessary before initiating or prescribing contraception, other than an intrauterine device, or to screen for STIs. However, a thorough history should be taken from each patient to ensure that there are no indications for performing a pelvic examination. If a patient is found to be asymptomatic, a discussion between the obstetrician–gynecologist and patient regarding the potential risks and benefits of performing a pelvic examination should ensue. Whether to perform a pelvic examination should be based on shared decision making.

  A pelvic exam is a doctor’s visual and physical examination of a woman’s reproductive organs. During the exam, the doctor inspects the vagina, cervix, fallopian tubes, vulva, ovaries, and uterus. Public and private healthcare providers routinely perform pelvic exams at their offices or clinics.

  When should you have a pelvic exam?

  There are no specific guidelines for how often a woman should have a pelvic exam, but it is often recommended to have one once a year. Depending on your medical history, a doctor may suggest that you have them more frequently. Women should have their first pelvic exam at age 21 unless other health issues require it earlier. Often the first pelvic exam is when a young woman goes to seek birth control.

  Women over the age of 21 should receive regular pelvic exams, similar to general checkups. However, special reasons for having a pelvic exam include:

  • unusual vaginal bleeding or discharge
  • a family history of cancer
  • concern about ovarian cancer, cysts, sexually transmitted diseases, and other gynecological problems

  Sometimes a doctor performs the exam before prescribing birth control.

  Preparing for a pelvic exam

  If you’ve never had a pelvic exam before, let your healthcare provider know when making your appointment. Schedule your pelvic exam for a date when you will not be on your period. However, if you have a menstrual issue you are concerned about, your doctor may suggest an examination during your period.

  Avoid vaginal intercourse, inserting anything into your vagina, and douching, at least 24 hours before your pelvic exam.

  What happens during a pelvic exam?

  Your doctor will have you undress and put on a robe. A breast exam may be included in the examination in which case you’ll be asked to remove your bra. You may be given something to put around your waist for added privacy. You will lie on an exam table with your legs spread and your feet on footrests called stirrups.

  Visual exam

  First, your doctor will visually inspect your vagina and vulva. Your doctor may be looking for redness, irritation, discharge, cysts, or something that indicates a sexually transmitted disease, such as sores.

  Speculum exam

  Next, the doctor will insert an instrument known as a speculum into the vagina. The speculum is a stainless steel or plastic device that resembles a duckbill. Women should breathe deeply and try to relax their vaginal, rectal, and abdominal muscles during insertion. Sometimes doctors will warm up the speculum beforehand.

  Pap smear

  The doctor may swipe the cervix, before removing the speculum, with something that looks like a small spatula. The spatula gathers cells for later examination. This procedure is known as a Pap smear. By looking at the cells, your doctor can diagnose conditions such as cancer and sexually transmitted diseases.

  Manual exam

  Your doctor will also manually inspect your internal reproductive and sexual organs. To do this, your doctor will put on lubricated gloves and insert two fingers into your vagina while using the other hand to feel your abdomen. This manual exam looks for irregularities in the uterus or ovaries.

  During this procedure, your doctor will be able to determine the size of your uterus. They can possibly check for pregnancy, as well as any abnormalities of the fallopian tubes.

  Finally, your doctor may perform a rectal examination. For this exam, the doctor inserts their fingers into both the rectum and vagina simultaneously to check for abnormalities in the tissue between the two organs.

  After the exam (adsbygoogle = window.adsbygoogle || []).push({});

  Your doctor will be able to tell you right away if any abnormalities were found. However, Pap smear results may take a few days. Your doctor may prescribe medications or require a follow-up visit.

  Benefits of a pelvic exam

  Pelvic exams are essential for determining a woman’s sexual and reproductive health. They can also detect life-threatening conditions, such as cancer or infections.

  Outlook

  Pelvic exams are routine, but you may have some discomfort during the procedure and spotting afterward.

  Many women find pelvic exams physically and mentally uncomfortable. Doctors try to make them as painless as possible and offer reassurance and feedback during the process. It might be helpful for you to prepare a set of questions you have for your doctor. You may also ask a friend or family to stay with you during your appointment.

  Researchshows that some groups of women are more inclined to feel physical and emotional discomfort during a pelvic exam. This includes adolescents, minorities, people with disabilities, and people who have been sexually assaulted. Healthcare providers will take special care during pelvic exams by using lubrication during instrument insertion and educating women about the process before getting started. If you feel uncomfortable at any point during your exam, make sure to tell your healthcare provider.

  Q:

  If a woman is younger than 21, doesn’t experience any unusual symptoms, but is sexually active, should she have a pelvic exam? What if she is older than 21 but is not sexually active?
  

  Anonymous patient

  A:

  Routine pelvic exams are an important procedure for all women to have regularly. A woman who is younger than 21 should begin getting pelvic exams at least once a year once she is sexually active. She can discuss safe sex behaviors, birth control options, and her risk for contracting sexually transmitted infections. Even if a woman is over the age of 21 and not sexually active, she should still see her gynecologist yearly to discuss other women’s health issues.

  What position should a patient be in for a pelvic exam?

  You'll lie on your back on an exam table with your knees bent and your feet placed on the corners of the table or in supports (stirrups). You'll be asked to slide your body toward the end of the table and let your knees fall open. A pelvic exam generally includes: External visual exam.

  In what position is the patient place in for a pelvic exam quizlet?

  During the vaginal examination, a patient should be placed in the lithotomy position. In this position, the patient's feet are at the level of the hips, and the perineum is at the edge of the table. This position provides good visual and physical access to the perineum.

  Which of the following is the most appropriate position for a pelvic examination and Pap smear?

  Cervical cancer screening tests are usually done during a pelvic exam, which takes only a few minutes. During the exam, you lie on your back on an exam table, bend your knees, and put your feet into supports at the end of the table.

  Which of the following is the best position for a patient undergoing gynecological examination?

  Lithotomy Position This position is typically used for gynecology, colorectal, urology, perineal, or pelvis procedures.