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ERROR: type should be string, got "https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTk0Nzk1Ni1vdmVydmlldw==\nPelvic Examination\nAuthor: Aurora M Miranda, MD, FACOG; Chief Editor: Christine Isaacs, MD more...\nSections Pelvic Examination\nVulvar Examination\nThe pelvic examination encompasses an examination of the vulva, vagina, and internal pelvic organs. Females typically undergo their first pelvic examination for the evaluation of gynecological complaints or at age 21 years, whichever comes first. Pelvic examinations were once performed for cervical cytology or screening for gonorrhea or chlamydia before age 21 years. However, the availability of urine testing for gonorrhea and chlamydia has reduced the necessity of routine pelvic examination before age 21 years.\nThe examination is a basic tool of physical diagnosis and can be performed by either physicians or trained allied health professionals. Few studies have addressed patient preference concerning pelvic examinations alone, but about 45% of women reported that they would prefer a female doctor for their gynecologic care, 4.2% reported that they would prefer a male doctor, and the remaining women expressed no preference. Many women anticipate that the nurse assisting the physician will give them additional information about the pelvic examination. [1]\nSince the American College of Obstetricians and Gynecologists (ACOG) guidelines changed the frequency of cervical cancer screening based on age and risk factors, many experts have begun to doubt the need for routine pelvic examination. An Agency for Healthcare Research and Quality (AHRQ)–commissioned report found no evidence that these examinations led to earlier detection of ovarian cancer. [2] In addition, no evidence has shown the benefits of a pelvic examination in the early diagnosis of other conditions in asymptomatic women. [2] Speculum and bimanual examinations are uncomfortable and disliked by many women and take up valuable time during a well-woman visit.\nAnnual pelvic examinations are often equated with the Papanicolaou (Pap) test, but they are separate tests. For women older than 21 years, the pelvic examination is typically performed as part of the well-woman visit, even when cervical screening is not indicated.\nChaperones typically accompany the provider performing the pelvic examination, although, in usual practice, female providers frequently do not have them present.\nFear of the pain associated with a pelvic examination is a barrier to consistent care, [3] and patients need reassurance. The clinician should establish patient rapport. Making the patient feel at ease, maintaining eye contact, being aware of the patient’s involuntary muscle contraction, selecting the appropriate speculum, clearly explaining the steps of the examination (and providing advanced warning of each step as the examination progresses), and explaining the findings are helpful during a pelvic examination. [4]\nThe pelvic examination is used to assess the mons, vulva, vagina, cervix, uterus, ovaries, and fallopian tubes and to note the urethra and bladder region. It is typically conducted annually starting at age 21 years.\nOther than cervical cancer screening and sexually transmitted disease (STD) testing, the primary indications for a pelvic examination are for the evaluation of the following pelvic complaints:\nPregnancy or postpartum\nPre-procedural evaluation\nPreoperative evaluation and planning\nSecond opinion/gynecologic consultation\nMenstrual abnormalities\nAbnormalities of sexual development\nUnexplained vaginal bleeding\nPelvic floor disorders\nDesire for transgender surgical procedures\nCheck the temperature of any warming devices or heating pads to avoid inadvertent pain or burn. Use disposable speculums or appropriately cleaned metal instruments.\nStandard OSHA guidelines regarding sterilization of reusable instrument must be observed.\nColposcopic instruments, laparoscopic instruments, ultrasonography, and office hysteroscopy are additonal tools to complete the comprehensive pelvic examination. The use of new technology (e.g., office hysterscopy) must be approved by the provider's institution based on safety profile and scientific evidence prior to use. The operator must be appropriately credentialed to use the specific instruments.\nContradications to the examination include the following:\nCritically unstable patient - medically, emotionally, psychologically\nInavailability of informed consent\nYanikkerem E, Ozdemir M, Bingol H, Tatar A, Karadeniz G. Women's attitudes and expectations regarding gynaecological examination. Midwifery. 2009 Oct. 25(5):500-8. [Medline]. [Full Text].\nHoyo C, Yarnall KSH, Skinner CS, Moorman PG, Sellers D, Reid L. Pain predicts nonadherence to Pap smear screening among middle-aged African American women. Prev Med. 2005. 41:439-45.\nAmerican College of Obstetricians and Gynecologists. Cervical Cytology Screening. ACOG Practice Bulletin No. 109. Obstet Gynecol. 2009. 114:1409-20.\nStormo AR, Hawkins NA, Cooper CP, Saraiya M. The pelvic examination as a screening tool: practices of US physicians. Arch Intern Med. 2011 Dec 12. 171(22):2053-4. [Medline].\nHenderson JT, Harper CC, Gutin S, Saraiya M, Chapman J, Sawaya GF. Routine bimanual pelvic examinations: practices and beliefs of US obstetrician-gynecologists. Am J Obstet Gynecol. 2013 Feb. 208(2):109.e1-7. [Medline].\nLarsen M, Oldeide CC, Malterud K. Not so bad after all...women's experiences of pelvic examinations. Fam Pract. 1997. 14:148-52.\nMyers ER, Bastian LA, Havrilesky LJ, Kulasingam SL, Terplan MS, Cline KE, et al. Management of Adnexal Mass. Evidence Report/Technology Assessment No.130 (Prepared by the Duke Evidence-based Practice Center under Contract No. 290-02-0025.) AHRQ Publication No. 06-E004. Rockville, MD: Agency for Healthcare Research and Quality; February 2006. [Full Text].\nWright D, Fenwick J, Stephenson P, Monterosso L. Speculum 'self-insertion': a pilot study. J Clin Nurs. 2005 Oct. 14(9):1098-111. [Medline].\nCandy cane type stirrups for lithotomy examination under anesthesia.\nExternal vulvar and vaginal structures for evaluation.\nBimanual examination.\nBimanual examination, lateral view.\nBimanual evaluation of the retroflexed and retroverted uterus.\nDiagram of retroverted uterus.\nDiagram of relative positions of anteverted and retroverted uterine positions.\nSims lateral examination position.\nKnee-chest examination position.\nGraves speculum.\nPederson speculum.\nAurora M Miranda, MD, FACOG Teaching Faculty, PGY 1 Residency Monitor, Residency Training Program, Medical Staff, Department of Obstetrics and Gynecology, West Penn Hospital; Clinical Associate Professor, Obstetrics and Gynecology and Reproductive Health Sciences, Department of Obstetrics and Gynecology, Lewis Katz School of Medicine at Temple University\nAurora M Miranda, MD, FACOG is a member of the following medical societies: AAGL, American College of Obstetricians and Gynecologists, American Institute of Ultrasound in Medicine, American Medical Association, American Urogynecologic Society, International Urogynaecology Association\nDiego A Vasquez de Bracamonte, MD Resident Physician, Department of Obstetrics and Gynecology, Allegheny Health Network, Western Pennsylvania Hospital\nDiego A Vasquez de Bracamonte, MD is a member of the following medical societies: Peruvian American Medical Society\nChristine Isaacs, MD Associate Professor, Department of Obstetrics and Gynecology, Division Head, General Obstetrics and Gynecology, Medical Director of Midwifery Services, Virginia Commonwealth University School of Medicine\nChristine Isaacs, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists\nSuzanne R Trupin, MD, FACOG Clinical Professor, Department of Obstetrics and Gynecology, University of Illinois College of Medicine at Urbana-Champaign; CEO and Owner, Women's Health Practice; CEO and Owner, Hada Cosmetic Medicine and Midwest Surgical Center\nSuzanne R Trupin, MD, FACOG is a member of the following medical societies: American Association of Gynecologic Laparoscopists, American College of Obstetricians and Gynecologists, American Institute of Ultrasound in Medicine, American Medical Association, Association of Reproductive Health Professionals, International Society for Clinical Densitometry, and North American Menopause Society\nencoded search term (Pelvic Examination) and Pelvic Examination\nCervical Cancer Staging\nCervical Cancer Imaging\nCervical Cancer Treatment Protocols\nSentinel Node Biopsy for Vulvar/Cervical Cancer\nPalliative Care of the Patient With Advanced Gynecologic Cancer\nCutting Through the Confusion About Pap Screening\nPredictive Testing of the Melanocortin 1 Receptor for Skin Cancer and Photoaging\nWhy 'Choosing Wisely' Won't Protect You in a Lawsuit\nCutaneous and Mucosal Manifestations of Viral Diseases\nDiseases & Conditions Cervical Cancer Staging\nDiseases & Conditions Cervical Cancer\nDiseases & Conditions Cervical Cancer Treatment Protocols\n2010 cervarix-human-papillomavirus-vaccine-bivalent-999308 Drugs\nDrugs human papillomavirus vaccine, bivalent"