Distress and Pain During Pelvic Examinations

Weitlauf, Julie C.; Finney, John W.; Ruzek, Josef I.; Lee, Tina T.; Thrailkill, Ann; Jones, Surai; Frayne, Susan M.

doi:10.1097/aog.0b013e31818e4678

Cited by 64 publications

(45 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…51 Post-traumatic stress disorder in women with trauma may increase the likelihood of anxiety. 52 While few women disclose a history of sexual trauma spontaneously, 53 a survey of women with a history of sexual abuse suggests that the majority favor routine inquiry. 54 Therefore, we suggest that all women, and especially those who have not had regular pelvic examinations or appear particularly uncomfortable, should be asked about a history of prior trauma.…”

Section: Sexual Trauma or Physical Abusementioning

confidence: 99%

The Challenging Pelvic Examination

2011

View full text Add to dashboard Cite

While there is a large body of evidence on the effectiveness of Pap smears for cervical cancer screening and on screening for cervical gonorrhea and Chlamydia, there is sparse evidence to support other portions of the pelvic examination and little guidance on examination logistics. Maximizing comfort should be the goal; lubrication use and careful speculum selection and insertion can ease this intrusive procedure. This is particularly important in adolescent and menopausal women, sexual minorities, obese women, women with disabilities, and women with a history of trauma or prior instrumentation affecting the genitalia. We review the evidence and provide guidance to minimize physical and psychological discomfort with pelvic examination. P elvic examinations are performed to evaluate pain, bleeding, and vaginal discharge and to screen for cervical cancer and sexually transmitted infections. Little attention has focused on the mechanics of pelvic examination technique, yet the examination is an intrusive experience for many women who feel exposed and lack control. 1 Emotional distress and fear of pain are cited as reasons for reduced adherence to cervical screening especially among adolescents, 2 racial/ethnic 3-5 and sexual minority groups, 6 obese women, 7 victims of sexual assault and other trauma, 8 and women with disabilities. 9 Therefore, examination should be limited to components with proven utility and should be performed with cultural sensitivity and procedural excellence, especially in clinical situations that require particular finesse. Accordingly, we review the clinical evidence as it exists, and in areas that lack evidence offer our own experience to optimize technical aspects of speculum choice and insertion, and suggest strategies to manage challenging circumstances. When recommendations are not referenced, we are relating our experience in the absence of evidence. Bimanual examination is not useful as a screening test for ovarian cancer because of limited sensitivity and specificity. In one study, ovaries were palpable in 55% of women under 200 lbs during examination under anesthesia, but in only 9% of women over 200 lbs. 14 In another study under similar circumstances, uterine size and contour were correctly assessed in over 50% of patients; however, sensitivity of examination for adnexal masses of 5 cm or greater was only 28% among attending gynecologists and 16% among gynecology residents. 15 The USPFTF acknowledges poor performance characteristics of the bimanual examination in its recommendation about screening for ovarian cancer. 11 In the non-screening setting, bimanual examination is inadequate to evaluate acute abdominal pain or vaginal bleeding, 16 since ultrasound is so much more sensitive and specific. COMPONENTS OF THE FEMALE PELVIC EXAMINATIONThe most evidence-based approach would therefore suggest Pap smear collection alone and the speculum examination required to achieve that goal. We suggest that bimanual and sometimes rectovaginal examinations may be important in evaluating pelvi...

show abstract

Section: Sexual Trauma or Physical Abusementioning

confidence: 99%

The Challenging Pelvic Examination

2011

View full text Add to dashboard Cite

show abstract

“…Indeed, prior research has documented a link between sexual violence and reactions of distress and anxiety during pelvic exams not only for women Veterans (Lee, Westrup, Ruzek, Keller, & Weitlauf, 2007;Weitlauf et al, 2008) but for women in the general population as well (Hilden, Sidenius, Langhoff-Roos, Wijma, & Schei, 2003;Leeners et al, 2007).…”

Section: Implications For Practice And/or Policymentioning

confidence: 99%

Challenges with Delivering Gender-Specific and Comprehensive Primary Care to Women Veterans

Bergman

Frankel

Hamilton

et al. 2015

Women's Health Issues

View full text Add to dashboard Cite

The growing presence of women Veterans in Veterans Health Administration (VA) settings has prompted the need for greater attention to clinical proficiency related to women's health (WH) primary care needs. Instead of making appointments for multiple visits or referring patients to a women's health clinic or alternate site for gender-specific care, a comprehensive primary care model now allows for women Veteran patients be seen by primary care providers (PCPs) who have WH training/experience and can see them for both primary and WH care in the context of a single visit. However, little is currently known about the barriers and facilitators WH-PCPs face in using this approach to incorporate gender-specific services to women Veterans' primary care needs. We conducted qualitative in-depth interviews with 22 WH-PCPs at one Midwestern VA Medical Center. All participants were members of one of four outpatient primary care clinics within the main medical center, one off-site satellite clinic, or two off-site community-based outpatient clinics (CBOCs). Inductive thematic analysis identified six themes: 1) time constraints, 2) importance of staff support, 3) necessity of sufficient space and equipment/supplies, 4) perceptions of discomfort among patients with trauma histories, 5) lack of education/training, and 6) challenges with scheduling/logistics. Although adequate staff was a key facilitator, the findings suggest that there may be barriers that undermine the ability of VA WH-PCPs to provide high quality comprehensive primary and gender-specific care. The nature of these barriers is multi-factorial and likely multi-level in nature, and may therefore require special policy and practice action.

show abstract

“…[14] The emotional contact between patient and examiner is of great importance as it leads to less discomfort for the patient during the gynaecological examination. [12,13] Patients who have experienced SA may find it difficult to raise this delicate subject during a consultation. As the primary confidant often over a longer period, the GP is in a suitable position to raise the topic.…”

Section: Introductionmentioning

confidence: 99%

“…It is a well-known fact that women with a history of SA report significantly more distress and pain during the pelvic examination. [12,13] Moreover, they tend to avoid the examination completely due to the additional distress. [14] The emotional contact between patient and examiner is of great importance as it leads to less discomfort for the patient during the gynaecological examination.…”

Section: Introductionmentioning

confidence: 99%