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A successful pelvic exam requires a conducive environment and good communication with your patient, as well as a gentle, trauma-informed care approach.
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Let’s Talk About Pronouns
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The pronouns used in this chapter are she/hers and refer to a patient who identifies as female. However, it is important to remember to check with your patient about preferred pronouns. While anyone with gynecologic organs may need the examinations described in this chapter, it should not be assumed that your patient identifies as female. Be familiar with gender-neutral pronouns such as they, them, their, zie, ze, and hir.
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It is important to recognize the high prevalence and significant impact that a prior traumatic experience may have for your patient. Many patients have experienced physical or sexual trauma in their lifetime, which they may or may not disclose. Your patient’s prior experience may impact your ability to conduct the exam and may mean your exam feels threatening or retraumatizing for them without your realizing it. Key aspects of trauma-informed care include the following:
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Creation of a physically and psychologically safe patient-provider relationship is critical to avoiding further psychological injury for your patient.
Fostering your patient’s sense of resiliency and control during your interactions improves overall health outcomes.
Clearly explaining how the exam can help direct her care and asking her permission to proceed keeps the patient in a position of power during the exam. You can often still provide good care without a pelvic exam, if the patient declines.
Providers can create a safer space for trauma-informed care if they take their time, move slowly, and empower the patient to stop the exam at any time.
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Indications for Performing a Pelvic Exam
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The decision to perform a pelvic examination should be collaborative between the patient and her provider. A pelvic exam should be performed when indicated by medical history or symptoms, typically for the following reasons:
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As part of preventative care for asymptomatic women to screen for gynecologic cancer and infection (eg, cervical cancer screening, sexually transmitted infection screening)
Evaluation of a patient complaint of lower abdominal pain or vaginal symptoms (eg, abnormal vaginal bleeding or discharge, lower abdominal pain, vaginal mass or lesion, pelvic organ prolapse, urinary incontinence)
As part of a routine full evaluation at the beginning of pregnancy
Prior to a gynecologic procedure or surgery, to identify the size and shape of the uterus (eg, prior to intrauterine device placement)
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Pelvic exams are invasive and require discussion with the patient prior to beginning. This should include the reason the exam is recommended, the steps involved, and obtaining your patient’s verbal consent prior to proceeding. Empower the patient to opt out or end the exam at any time if needed.
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