Pelvic Examination Experience Research Articles

Improving the initial pelvic examination experience among college health patients: A quality improvement project

Although tens of millions of pelvic exams are performed in the United States each year, improved education is indicated as a critical need during the well-woman visit to improve the patient’s health literacy, decrease exam-related fears, and promote follow through with additional tests and treatments.

What influences GPs' use of pelvic examination? A qualitative investigation in primary care.

Omission of pelvic examination (PE) has been associated with diagnostic delay in women diagnosed with gynaecological cancer. However, PEs are often not carried out by GPs. To determine the perceptions of GPs about the role of PEs, the barriers to and facilitators of PEs, and GPs' experience of PEs in practice. Qualitative semi-structured interview study conducted in one health board in Scotland (mixed urban and rural) with an approximate population of 500 000. Interviews were conducted face-to-face or by telephone between March and June 2019. Framework analysis used the COM-B behaviour change model concepts of capability, opportunity, and motivation. Data was compatible with all three domains of the COM-B framework. Capability related to training in and maintenance of skills. These went beyond carrying out the examination to interpreting it reliably. Opportunity related to the clinical environment and the provision of chaperones for intimate examination. Interviewees described a range of motivations towards or against PEs that were unrelated to either capability or opportunity. These all related to providing high-quality care, but this was defined in different ways: 'doing what is best for the individual', 'doctors examine', and 'GPs as pragmatists'. GPs' reasons for carrying out, or not carrying out, PEs in women with symptoms potentially indicating cancer are complex. The COM-B framework provides a way of understanding this complexity. Interventions to increase the use of PEs, and critics of its non-use, need to consider these multiple factors.

Optimised gynaecological examination with a new pelvic examination chair

ObjectiveThe present aim was to contribute to improving the traditional pelvic examination chair with vertical leg support and to evaluate patients’ and examiners’ experience of a new gyneacological and urological examination chair with heated upholstery. Study designA new gynaecological and urological examination chair was constructed with laterally adjustable leg support, a foot-plate and the perineum exposed only during the examination procedure. Patients (n = 131) with or without endometriosis were invited to participate in an anonymous questionnaire survey concerning how they experienced a gynaecological examination. Main outcome measuresThe patients and the gynaecologists who performed the examinations answered questionnaires evaluating the examination procedure in the traditional and in the new gynaecological and urological examination chair, respectively. The questionnaires asked about comfort, heating, integrity and the experience of pelvic examination with vertical or lateral leg support. The examination times were measured with a stop-watch. ResultsThe majority of the answers (n = 131) were significantly (p < 0.05–0.001) in favour of the new concept with lateral leg support and with increased comfort and integrity. The average examination time was significantly shortened and the patients more relaxed in the new gynaecological and urological examination chair. ConclusionThe traditional gynaecological chair with vertical leg support has remained basically unchanged for many years. The present study showed that the pelvic examination procedure can be significantly optimized with easy patient-friendly adaptations.

Factors Influencing Adolescent and Young Adults' First Pelvic Examination Experiences: A Qualitative Study.

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. 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. 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.

Exploring Jordanian women's experience of first pelvic examination

• The key finding is that “Jordanian women have a very negative experience of Pelvic Examination.”

Using a wrap skirt to improve the pelvic examination experience.

The study aims were to analyze the experience of women and their physicians of nakedness when moving between changing room and examination chair and during pelvic examination itself, and to assess the protective benefit of a wrap skirt in alleviating the associated discomfort and vulnerability. We offered 1000 women a wrap skirt for pelvic examination and asked them to complete a post-procedure questionnaire. Physicians were invited to complete a similar but separate questionnaire. Data were analyzed using chi-squared contingency tables. A total of 425 women (43%, age 15-78 years) completed the questionnaire; 51% felt uncomfortable and embarrassed during the examination, Muslim women significantly more so (p < 0.001). Most women (n = 255; 58%) rated the wrap skirt a significant improvement; 69% requested it for future examinations, significantly more so if the physician was male rather than female (66% vs. 54%, p = 0.003). Even the one-third of women experiencing no discomfort reported improvement. Most examiners (n = 45; 56%) found the wrap skirt beneficial; 31 (38%) were unconvinced. Pelvic examination as practiced in many countries, on women naked from the waist down throughout, causes unnecessary embarrassment. A simple protective measure, such as a wrap skirt, significantly alleviates the discomfort and sense of vulnerability associated with nakedness.

Creating a more positive patient experience of pelvic examination

To explore through descriptive comparative analysis an alternative method of pelvic examination to increase patient comfort. Sixty-two participants were recruited from a convenience sample of patients at an ambulatory women's healthcare clinic operated by a teaching hospital in the Southwest United States. Twenty-five were examined using the conventional pelvic examination technique; 37 with a new technique that we call the Rad technique, named after a co-author of the study. Three women's health nurse practitioners were trained in both methods and alternated the exam technique used. Visualization of the cervix was measured by clinician responses to the Speculum Exam Questionnaire for Clinicians; level of pain was determined from patient responses to the Wong-Baker FACES Pain Rating Scale. Results were analyzed using a t-test for independent samples. Pain was further analyzed using chi-square test of association. Although the relationship between the variables of visualization and pain was not statistically significant, 16% of women in the conventional technique group reported vaginal pain compared with 5.4% in the Rad technique group. Changing from the conventional pelvic examination to the Rad technique may create a more positive patient experience and thereby engage more women in recommended in gynecological health care.

Pre-clerkship Preparation from Live Patient Practice Pelvic Examinations

Our previous survey found students perceived live patient practice pelvic examinations (PPE) helpful for clinical rotations. Therefore, we wanted to follow up after Obstetrics and Gynecology (Ob/Gyn) rotations to determine if the experience was truly preparatory. This study tested the hypothesis that practice pelvic examinations on a live teaching patient during the pre-clinical medical school curriculum increases students’ knowledge, confidence and comfort during the clinical years Ob/Gyn clerkships. Questionnaires were emailed to third and fourth year medical students. Sixteen questions were asked related to demographics, pelvic examination experience, and perceptions regarding experience during Ob/Gyn clerkship. Data were collected and descriptive statistics generated. Ninety-seven students (28%) completed the survey (36 male, 61 female). As a result of the PPE experience with a live teaching patient, 96% students felt prepared for their first pelvic examination during rotations. During rotations, 91% students felt more confident/comfortable performing their first examination; 92% indicated knowing what (and how) to tell the patient about the examination; 92% knew how to hold a speculum; 91% knew how to bimanually locate the cervix. Additionally, 92% students would feel confident/capable performing a pelvic examination, without physician assistance. Furthermore, 95% students agreed/strongly agreed that the teaching patient pelvic examination experience during pre-clinical medical school curriculum helped prepare them for clinical rotations. Results indicate that PPEs, utilizing a live teaching patient, improve medical student confidence and comfort during this examination in clinical clerkships. By alleviating anxiety during sensitive examinations, this experience will improve the clinical experience of medical students, physicians, and patients.

Home STI testing: The adolescent female’s opinion

Purpose To assess sexually active adolescent females’ attitudes of home tests for sexually transmitted infections. Methods This study represents a follow-up to a study on adolescent attitudes toward different sampling methods for STI testing. In the initial study participants completed a pre-examination health survey, provided first void urine (FVU) and self-collected vaginal swab samples followed by a pelvic examination with STI screening by endocervical swabs. Participants’ attitudes about the three collection techniques were assessed at the end of the visit. For the current study, this same group of ethnically diverse adolescents (13–20-years-old) was contacted by telephone 9 months after their initial clinic visit to re-assess their attitudes about the three specimen collection techniques and to evaluate their attitudes regarding the use of home STI testing. Friedman tests of mean ranks evaluated teens’ rankings of STI sampling methods and multivariate regression analysis was used to identify predictors of home test preference. Results Home urine testing was the first choice for STI screening followed by the FVU, self-obtained vaginal swab and endocervical swab collected in a clinical setting. FVU was preferred to self-collected vaginal swabs ( p = .01). Adolescents who worried about having an STI were more likely to favor home urine testing (OR 5.5, p = .01). Only 22% would seek any STI screening if asymptomatic. Conclusions Because young women preferred home STI testing, this may be an additional option, as the foundation for such testing kits has progressed. Adolescent preferences may be heavily influenced by the pelvic examination experience. Because of the largely asymptomatic nature of CT infections, multiple screening options (clinical and home-based) need to be available to increase access to care.

Home STI testing: The adolescent femaleʼs opinion

<h2>Abstract</h2><h3>Purpose</h3> To assess sexually active adolescent females' attitudes of home tests for sexually transmitted infections. <h3>Methods</h3> This study represents a follow-up to a study on adolescent attitudes toward different sampling methods for STI testing. In the initial study participants completed a pre-examination health survey, provided first void urine (FVU) and self-collected vaginal swab samples followed by a pelvic examination with STI screening by endocervical swabs. Participants' attitudes about the three collection techniques were assessed at the end of the visit. For the current study, this same group of ethnically diverse adolescents (13–20-years-old) was contacted by telephone 9 months after their initial clinic visit to re-assess their attitudes about the three specimen collection techniques and to evaluate their attitudes regarding the use of home STI testing. Friedman tests of mean ranks evaluated teens' rankings of STI sampling methods and multivariate regression analysis was used to identify predictors of home test preference. <h3>Results</h3> Home urine testing was the first choice for STI screening followed by the FVU, self-obtained vaginal swab and endocervical swab collected in a clinical setting. FVU was preferred to self-collected vaginal swabs (<i>p</i> = .01). Adolescents who worried about having an STI were more likely to favor home urine testing (OR 5.5, <i>p</i> = .01). Only 22% would seek any STI screening if asymptomatic. <h3>Conclusions</h3> Because young women preferred home STI testing, this may be an additional option, as the foundation for such testing kits has progressed. Adolescent preferences may be heavily influenced by the pelvic examination experience. Because of the largely asymptomatic nature of CT infections, multiple screening options (clinical and home-based) need to be available to increase access to care.

Acquisition of pelvic examination skills: Evaluation of student feelings about a surrogate patient program

Two hundred and eight second-year students were matched with respect to gender, age, academic standing, minority status, and prior pelvic examination experience. After didactic instruction, individuals from each matched pair were randomly assigned to alternate training modalities—a plastic pelvic model (Gynny) and surrogate patients (Gynecology Teaching Associates, GTAs)—for pelvic examination instruction. A sample of 52 study- and 54 control-group students were then evaluated while they examined women with normal or deviant (hysterectomy/ pregnancy) pelvic anatomy. Communication and manual skills were evaluated on the basis of specially designed instruments in which the components of a ‘good’ pelvic examination were identified and described. Immediately after the objective evaluation, each student was interviewed to determine his/her subjective feelings about the training experience. The subjective data obtained in this way indicated that students evaluated the GTA modality significantly more favorably t...