A Guide to Performing Pelvic Speculum Exams: A Patient-Centered Approach to Reducing Iatrogenic Effects

Abstract

Although PSEs can lead to adverse outcomes, awareness of the iatrogenic effects allows clinicians to utilize techniques to prevent or reduce negative effects. A method of incorporating techniques described in this article into teaching is provided.

Describing the healthcare experiences and strategies of women survivors of violence

“…Recent publications do affirm findings from this study that elements of routine care can recall traumatic memories. Williams and Williams () cited pain and exposure of the genitals as elements of gynaecological examination that could recall trauma and cause distress.…”

“…Even in the context of sensitive screening and trusting provider–patient relationships, findings from this study indicate that survivors may still not choose to disclose their trauma history or be able to articulate their needs for care. Therefore, providers should take responsibility for reading and responding to cues or behaviours (e.g., fast, shallow breathing) that indicate distress (Williams & Williams, ). Discussing trauma history and healthcare needs and observing patient distress are both opportunities for providers to deliver more sensitive care.…”

“…Women are more likely to experience assaultive traumatic life events (e.g., rape, childhood sexual abuse, physical IPV; Olff, ), and the dual psychological and physical nature of such violence places survivors at particularly high risk for experiencing trauma symptoms during healthcare procedures and examinations. For instance, survivors of sexual violence reported experiencing dissociation, overwhelming emotions and/or intrusive thoughts or memories during physical examinations (Coles & Jones, ; Williams & Williams, ). Fortunately, implications for trauma‐informed and sensitive practice are well established in existing literature (Reeves, ).…”

“…Seeking out and receiving health care can be associated with physical and psychological intrusions that are linked with prior traumatic life events for women survivors of violence. These women may be inadvertently re-traumatised or distressed by elements of routine care such as physical touch, supine body positioning and the power imbalance between provider and patient (Coles & Jones, 2009;Schnur, Dillon, Goldsmith, & Montgomery, 2017;Seng & Hassinger, 1998;Williams & Williams, 2013). As a result of the prevalence of violence in the lives of women, most healthcare providers are likely to encounter survivors in their practice but may be unaware due to failure to screen or lack of disclosure.…”

“…For instance, survivors of sexual violence reported experiencing dissociation, overwhelming emotions and/or intrusive thoughts or memories during physical examinations (Coles & Jones, 2009;Williams & Williams, 2013). Fortunately, implications for traumainformed and sensitive practice are well established in existing literature (Reeves, 2015).…”