Internal examination

A pelvic examination is the physical examination of the external and internal female pelvic organs. It is called 'bimanual exam' when two hands are used and 'manual uterine palpation' (palpation meaning an examination by touch). It is frequently used in gynecology. It can also be done under general anesthesia. A pelvic examination is the physical examination of the external and internal female pelvic organs. It is called 'bimanual exam' when two hands are used and 'manual uterine palpation' (palpation meaning an examination by touch). It is frequently used in gynecology. It can also be done under general anesthesia. The examination can be uncomfortable. During the pelvic exam the vaginal wall is assessed for rugae, texture and weak spots. In addition to a thorough pelvic exam, other tests may ordered to further determine the cause of symptoms that are concerning. During the pelvic exam, samples of vaginal fluids may be taken to screen for sexually transmitted infections or other infections. Some clinicians combine a routine pelvic exam along with other preventative procedures like a breast examination and pap smear. The American College of Physicians published guidelines against routine pelvic examination in adult women who are not pregnant and lack symptoms in 2014. One exception being pelvic exams done as part of cervical cancer screening. A pelvic examination can be part of the assessment of sexual assault. Previous to July 2014 the benefits of routine pelvic examinations were not clear and there was no consensus. Since then, American College of Physicians (ACP) issued a guideline recommending against performing this examination to screen for conditions in asymptomatic, nonpregnant, adult women. (The guideline did not consider pap smears.) The ACP said that there was no evidence of benefit in support of the examination, but there was evidence of harm, including distress and unnecessary surgery. This was a strong recommendation, based on moderate-quality evidence. In 2018, the American College of Obstetricians and Gynecologists (ACOG) issued a committee opinion that pelvic exams should be performed for 1) symptoms of gynecologic disease, 2) screening for cervical dysplasia, or 3) management of gynecologic disorders or malignancy, using shared decision-making with the patient. ACOG concluded there is inadequate data to support recommendations for or against routine screening pelvic examination for asymptomatic, non-pregnant women with average risk for gynecologic disease. Annual well-woman exams are an occasion for gynecologists to recognize issues like incontinence and sexual dysfunction, and discuss patient concerns. The pelvic exam begins with an explanation of the procedure. The woman is asked to put on an examination gown, get on the examination table, lay on her back with her feet in stirrups. Sliding down toward the end of the table is the best position for the clinician to do a visual examination. A pelvic exam begins with an assessment of the reproductive organs that can be seen without the use of a speculum. Many women may want to 'prepare' for the procedure. Douching before the exam is discouraged because cells needed from the cervix to assess for cervical cell abnormalities may be washed out. One possible reason for delaying an exam is if it is to be done during menstruation, but this is a preference of some women and not a requirement of the clinician. The woman will probably will be asked to put on an examination gown and lay down on the examination table. A girl or woman may ask to have another woman in the examination room during the exam. The clinician may want to perform pelvic examination and assessment of the vagina because there are unexplained symptoms of vaginal discharge, pelvic pain, unexpected bleeding, or urinary problems.