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Journal of General Internal Medicine Jun 2011While 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... (Review)
Review
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.
Topics: Clinical Competence; Female; Gynecological Examination; Humans; Papanicolaou Test; Patient Education as Topic; Sexual Behavior; Sexually Transmitted Diseases; Vaginal Smears
PubMed: 21225474
DOI: 10.1007/s11606-010-1610-8 -
American Family Physician Apr 2011Bacterial vaginosis, trichomoniasis, and vulvovaginal candidiasis are the most common infectious causes of vaginitis. Bacterial vaginosis occurs when the normal... (Review)
Review
Bacterial vaginosis, trichomoniasis, and vulvovaginal candidiasis are the most common infectious causes of vaginitis. Bacterial vaginosis occurs when the normal lactobacilli of the vagina are replaced by mostly anaerobic bacteria. Diagnosis is commonly made using the Amsel criteria, which include vaginal pH greater than 4.5, positive whiff test, milky discharge, and the presence of clue cells on microscopic examination of vaginal fluid. Oral and topical clindamycin and metronidazole are equally effective at eradicating bacterial vaginosis. Symptoms and signs of trichomoniasis are not specific; diagnosis by microscopy is more reliable. Features of trichomoniasis are trichomonads seen microscopically in saline, more leukocytes than epithelial cells, positive whiff test, and vaginal pH greater than 5.4. Any nitroimidazole drug (e.g., metronidazole) given orally as a single dose or over a longer period resolves 90 percent of trichomoniasis cases. Sex partners should be treated simultaneously. Most patients with vulvovaginal candidiasis are diagnosed by the presence of vulvar inflammation plus vaginal discharge or with microscopic examination of vaginal secretions in 10 percent potassium hydroxide solution. Vaginal pH is usually normal (4.0 to 4.5). Vulvovaginal candidiasis should be treated with one of many topical or oral antifungals, which appear to be equally effective. Rapid point-of-care tests are available to aid in accurate diagnosis of infectious vaginitis. Atrophic vaginitis, a form of vaginitis caused by estrogen deficiency, produces symptoms of vaginal dryness, itching, irritation, discharge, and dyspareunia. Both systemic and topical estrogen treatments are effective. Allergic and irritant contact forms of vaginitis can also occur.
Topics: Administration, Intravaginal; Administration, Oral; Anti-Bacterial Agents; Anti-Infective Agents; Antifungal Agents; Atrophic Vaginitis; Bacterial Load; Candidiasis, Vulvovaginal; Clindamycin; Estrogens; Female; Gynecological Examination; Humans; Hydrogen-Ion Concentration; Metronidazole; Microscopy; Treatment Outcome; Trichomonas Vaginitis; Vaginal Discharge; Vaginosis, Bacterial
PubMed: 21524046
DOI: No ID Found -
CMAJ : Canadian Medical Association... Sep 2021
Topics: Canada; Crime Victims; Female; Genitalia; Gynecological Examination; Gynecology; Humans; Male; Obstetrics; Physical Examination; Referral and Consultation
PubMed: 34518351
DOI: 10.1503/cmaj.210331-f -
Obstetrics and Gynecology Dec 2019The pelvic examination is a critical tool for the diagnosis of women's health conditions and remains an important skill necessary for students to master before becoming...
The pelvic examination is a critical tool for the diagnosis of women's health conditions and remains an important skill necessary for students to master before becoming physicians. Recently, concerns regarding student involvement in pelvic examinations-specifically those performed while a woman is under anesthesia-have been raised in the scientific, professional, and lay literature. These concerns have led to calls to limit or halt the performance of pelvic examinations by students while a woman is under anesthesia. Although ensuring adequate informed consent for teaching pelvic examinations is a priority, we must not lose sight of the critical pedagogical value of teaching pelvic examination in familiarizing students with the female anatomy and instilling a physician workforce with confidence in pelvic examination skills. A compromise that addresses all of these values is possible. In this commentary, we review the educational and legal aspects of the pelvic examination under anesthesia, then provide strategies that individuals and institutions can consider to optimize processes regarding consent for pelvic examination under anesthesia.
Topics: Anesthesia, General; Clinical Clerkship; Education, Medical, Undergraduate; Female; Gynecological Examination; Gynecology; Humans; Informed Consent; Practice Guidelines as Topic; Societies, Medical; Students, Medical; United States
PubMed: 31764743
DOI: 10.1097/AOG.0000000000003560 -
American Family Physician Apr 2012Pelvic inflammatory disease is a polymicrobial infection of the upper genital tract. It primarily affects young, sexually active women. The diagnosis is made clinically;... (Review)
Review
Pelvic inflammatory disease is a polymicrobial infection of the upper genital tract. It primarily affects young, sexually active women. The diagnosis is made clinically; no single test or study is sensitive or specific enough for a definitive diagnosis. Pelvic inflammatory disease should be suspected in at-risk patients who present with pelvic or lower abdominal pain with no identified etiology, and who have cervical motion, uterine, or adnexal tenderness. Chlamydia trachomatis and Neisseria gonorrhoeae are the most commonly implicated microorganisms; however, other microorganisms may be involved. The spectrum of disease ranges from asymptomatic to life-threatening tubo-ovarian abscess. Patients should be treated empirically, even if they present with few symptoms. Most women can be treated successfully as outpatients with a single dose of a parenteral cephalosporin plus oral doxycycline, with or without oral metronidazole. Delay in treatment may lead to major sequelae, including chronic pelvic pain, ectopic pregnancy, and infertility. Hospitalization and parenteral treatment are recommended if the patient is pregnant, has human immunodeficiency virus infection, does not respond to oral medication, or is severely ill. Strategies for preventing pelvic inflammatory disease include routine screening for chlamydia and patient education.
Topics: Administration, Oral; Anti-Bacterial Agents; Biopsy; Chlamydia trachomatis; Diagnostic Imaging; Drug Therapy, Combination; Endometrium; Female; Gynecological Examination; Hospitalization; Humans; Infusions, Parenteral; Male; Mass Screening; Medical History Taking; Neisseria gonorrhoeae; Nucleic Acid Amplification Techniques; Pelvic Inflammatory Disease; Pregnancy; Risk Factors; Sexual Partners
PubMed: 22534388
DOI: No ID Found -
Reproductive Health May 2017So-called virginity testing, also referred to as hymen, two-finger, or per vaginal examination, is the inspection of the female genitalia to assess if the examinee has... (Review)
Review
BACKGROUND
So-called virginity testing, also referred to as hymen, two-finger, or per vaginal examination, is the inspection of the female genitalia to assess if the examinee has had or has been habituated to sexual intercourse. This paper is the first systematic review of available evidence on the medical utility of virginity testing by hymen examination and its potential impacts on the examinee.
METHODS
Ten electronic databases and other sources for articles published in English were systematically searched from database inception until January 2017. Studies reporting on the medical utility or impact on the examinee of virginity testing were included. Evidence was summarized and assessed via a predesigned data abstraction form. Meta-analysis was not possible.
MAIN RESULTS
Seventeen of 1269 identified studies were included. Summary measures could not be computed due to study heterogeneity. Included studies found that hymen examination does not accurately or reliably predict virginity status. In addition, included studies reported that virginity testing could cause physical, psychological, and social harms to the examinee.
CONCLUSIONS
Despite the lack of evidence of medical utility and the potential harms, health professionals in multiple settings continue to practice virginity testing, including when assessing for sexual assault. health professionals must be better informed and medical and other textbooks updated to reflect current medical knowledge. Countries should review their policies and move towards a banning of virginity testing.
Topics: Female; Gynecological Examination; Humans; Sexual Abstinence
PubMed: 28521813
DOI: 10.1186/s12978-017-0319-0 -
Obstetrics & Gynecology Science Jul 2022In this video, we present our technique for ureter assessment during pelvic ultrasound examination.
OBJECTIVE
In this video, we present our technique for ureter assessment during pelvic ultrasound examination.
METHODS
We used a general electric Voluson E10 (General electric, Wauwatosa, WI, USA) to perform transvaginal ultrasonography. These images were shared after thorough counselling, and obtaining informed consent from the patient. This video was edited using FinalCut ProX® (Apple Inc, Cupertino, CA, USA).
RESULTS
We systematized this routine after assessing the cervix, uterus, and adnexa. The vaginal probe was slightly removed to focus on the urethra. Next, we approached the hand on the contralateral thigh to the ureter. At this point, the probe was directed to the lateral pelvic wall where the ureteric orifice was found. Then, we raised our hands and perform an internal rotation movement to ascend the ureteral segments until it is related to the iliac vessels.
CONCLUSION
The urinary tract may be involved in gynecological pathologies. Transvaginal ultrasound is an easy, reproducible, and well-tolerated examination that can be used to evaluate the ureters below the pelvic brim.
PubMed: 35681270
DOI: 10.5468/ogs.21194 -
Journal of Gynecology Obstetrics and... Dec 2023Pelvic examination including vaginal digital examination and speculum inspection are crucial medical skills that are challenging to teach for both professors and... (Review)
Review
OBJECTIVE
Pelvic examination including vaginal digital examination and speculum inspection are crucial medical skills that are challenging to teach for both professors and students, because of its intimate nature. Consequently, education has shifted from a traditional approach to a simulation-enhanced education. This literature review summarizes the level of evidence for these not-so-new training modalities.
METHODS
For this systematic review, the Pudmed database have been consulted using the following keywords: (Pelvic examination OR Vaginal examination) AND simulation. Eligible studies had to be published in French or English within the past 20 years and investigate simulation training for pelvic examination in the field of gynecology and obstetrics. For each paper, the following outcomes were analyzed: Competence, confidence and communication, and were classified according to the Kirkpatrick hierarchy.
RESULTS
About competence, in initial training, one meta-analysis (9 studies of which 4 randomized studies) about pelvic examination teaching on procedural simulators have shown a significant benefit of simulation. One meta-analysis and one systematic review also demonstrated that Gynecological Teaching Associates (GTAs) teaching, who exist in Northern America and Scandinavian countries, was better that pelvic task trainers in terms of technical competence, and comfort. For the vaginal examination of women in labor, two randomized trials also showed a positive impact of pelvic task trainer on students' accuracy.
CONCLUSION
Simulation-enhanced education of pelvic examination brings a significant benefit in comparison to a classic education without simulation in terms of competence, confidence and communication. GTAs have the best impact on competence and communication, but they do not exist currently in France. Hybrid simulation (a patient actor combined with a pelvic task trainer) could be a solution to teach both technical skills and communication.
Topics: Female; Humans; Pregnancy; Education, Medical, Undergraduate; Gynecological Examination; Gynecology; Patient Simulation; Simulation Training
PubMed: 37739264
DOI: 10.1016/j.jogoh.2023.102666 -
Journal of Pediatric and Adolescent... Jun 2019To understand the factors that influence individuals' experiences during their first pelvic examination. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME...
STUDY OBJECTIVE
To understand the factors that influence individuals' experiences during their first pelvic examination. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: We conducted semistructured interviews with adolescents and young adults, aged 18-24, who had received at least 1 pelvic examination. Interviews explored contextual factors of the first pelvic examination, including visit acuity and clinical setting and individuals' experiences with the pelvic examination itself and elicited recommendations on how to improve the examination experience. Interviews were transcribed and computer-assisted content analysis was performed; salient themes are presented.
RESULTS
Thirty participants completed interviews. Nineteen participants described their first pelvic examination experience as positive; 11 described this examination as a negative or neutral experience. Factors influencing the experience include the examination indication and acuity, examination location and physical space, provider features, relational and interpersonal features, and procedural aspects. Recommendations included: (1) establish rapport and educate before the examination; (2) establish practices to orient patients; (3) make no assumptions about identity; and (4) elicit continuous feedback.
CONCLUSION
Individuals' first pelvic examination experiences are influenced by a variety of factors. Although some factors are directly modifiable by providers, other factors that might not be modifiable are important to elicit to optimize the examination experience. These findings call for best practice guidelines and educational interventions to prepare providers to perform the first pelvic examination.
Topics: Adolescent; Adult; Female; Gynecological Examination; Gynecology; Humans; Patient Satisfaction; Physician-Patient Relations; Qualitative Research; Young Adult
PubMed: 30395982
DOI: 10.1016/j.jpag.2018.10.008