Pelvic Examination Research Articles (Page 1)

Background Little is known about the effect of including pelvic floor muscle relaxation exercises (PFMRE) in a physiotherapy management plan for pelvic pain. Aims This retrospective study evaluated the effect of PFMRE audio files on pelvic pain. It was hypothesised that audio files guiding PFMRE would result in less self-reported pain on digital examination of the pelvic floor muscles. Methods Patient files from a private pelvic health physiotherapy practice were assessed for reports of pain during pelvic floor muscle examination, pre- and post-PFMRE, between August 2020 and August 2022. All patients had chronic pelvic pain, were examined by the same practitioner, and used the same audio files (produced by the treating practitioner). A numerical rating scale (NRS) was used to rate pain. Examinations were conducted approximately 4 weeks apart. Results Fifty-eight patients were eligible to be part of this study. There was a significant decrease in self-reported pain post-PFMRE treatment in both the superficial (mean pain score 2.21 (s.d. 2.33), P < 0.001) and deep pelvic floor muscles (mean pain score 1.12 (s.d. 1.99), P < 0.001). Effect sizes of 2.15 and 2.46 were found for the superficial and deep pelvic floor muscle respectively. Conclusion Pelvic floor muscle relaxation exercise audio files appear to be a useful treatment adjunct to reduce self-reported pain during examination of the pelvic floor muscles. This provides initial insight into how relaxation strategies may fit into multi-modal physiotherapy management programs for chronic pelvic pain. Limitations include the fact that patients were adhering to other treatment advice from the treating practitioner and management advice from other health professionals in their team at the same time.

Effectiveness and safety of medication abortion with vs without screening ultrasonography or pelvic examination.

A sexually inactive nulliparous woman in her early 30s presented with persistent pain in the left iliac fossa that had lasted for two years, intensifying over the past two months. An initial ultrasound suggested the possibility of a left adnexal cyst, which prompted treatment with oral contraceptives for months; however, her symptoms continued unabated. Subsequent pelvic MRI revealed a multiloculated cystic lesion, which was suspected to arise from the cervix. After robust counselling and consent, an examination under anaesthesia revealed a pedunculated cervical mass, which was excised and later confirmed via histopathological analysis as a giant endocervical polyp and hence an unnecessary scar abdomen was avoided. This case highlights the diagnostic challenges posed by the benign cervical lesions that can mimic adnexal pathology, especially when per speculum examination cannot be done, and it emphasises the critical need for correlation between imaging results, clinical evaluations and operative findings to avoid diagnostic delay and unwarranted radical surgeries.

Delays to colposcopy increase the risk for cervical cancer development. Our study sought to understand the barriers and facilitators to follow-up after an abnormal cervical cancer screening test result. English-speaking adult patients who did not attend at least one of their scheduled appointments at an urban academic colposcopy clinic between June 2021 and June 2023 were eligible. Semistructured interviews were conducted, and thematic analyses using inductive and deductive coding were completed. Twenty women were interviewed. The mean (SD) age was 34 (10) years, and participants mainly identified as non-Hispanic Black (60%). The mean (SD) time to colposcopy was 12.5 (11.9) months. Seven participants did not have a follow-up colposcopy at the time of the interview. Five categories of themes emerged at the individual, interpersonal, clinic, and system level, including (1) fear of pain and/or pelvic examinations, (2) patient-provider communication (including result communication), (3) clinic interactions (including presence of trainees and lack of continuity), (4) scheduling difficulties, and (5) system-level barriers such as loss of insurance coverage. Barriers to follow-up care exist across multiple levels. A one-size-fits-all approach may be ineffective for facilitating follow-up; rather, a multipronged approach may be needed to improve adherence and reduce delays to follow-up care after an abnormal cervical cancer screening test result.

Barriers to cervical cancer screening are significantly higher among US rural populations. To understand these barriers and explore potential remedies, we compare perceptions of screening exam techniques, pelvic exam vs. self-sampling, and how perceptions vary by participants' beliefs, physician characteristics, and known barriers among under-screened rural people in Michigan, United States. Our mixed-methods study explored experiences with a vaginal self-sampling technique in comparison to the memory of the most recent pelvic exam. We developed quantitative survey questions using Health Information National Trends Survey (HINTS) modules. We created the qualitative interview guide using Likert scales and the Theoretical Domains Framework (TDF). We provided vaginal self-sampling kits (HerSwab) to participants to try this new test modality. We used descriptive statistics and t tests to analyze quantitative data. We analyzed the interview responses thematically. Of the forty rural white women who shared their experiences of the two screening techniques, the pelvic exam technique had significantly worse negative ratings across all fourteen perceptions than the self-sampling technique, and the self-sampling technique had significantly higher positive ratings. Analysis of interviews revealed four themes that elaborated survey results: 1) preference for the self-sampling technique; 2) physical and emotional discomfort with the pelvic exam technique; 3) convenience of the self-sampling technique; and 4) empowerment through self-sampling. The powerful negative perceptions of the pelvic exam may be why people do not participate in screening. The self-sampling cervical cancer screening technique offers a quick and easy method for screening that many prefer.

Aims: This study aimed to compare the perinatal outcomes of singleton pregnancies undergoing emergency cervical cerclage (ECC) indicated by physical examination, based on the presence or absence of prolapsed fetal membranes. Methods: In this retrospective cohort study, a total of 80 singleton pregnancies that underwent ECC due to cervical insufficiency between April 2023 and April 2025 were analyzed. Patients were divided into two groups according to whether prolapsed fetal membranes were observed during speculum examination: the prolapsed group (n=35) and the non-prolapsed group (n=45). Maternal demographic characteristics, laboratory parameters, as well as obstetric and neonatal outcomes, were compared between the groups. Appropriate parametric or non-parametric tests were used for statistical analyses. A binary logistic regression analysis was performed to identify independent predictors of NICU admission. Results: The two groups were comparable regarding maternal age, body-mass index (BMI), and parity (p>0.05). Inflammatory parameters showed significant differences: the prolapsed group had higher white blood cell and neutrophil counts, as well as elevated CRP levels (all p

BackgroundThe benefit of patient involvement in medical education has been widely described. In particular, patient story-telling and sharing of personal experiences has been shown to increase study empathy and connection to patients. Patient involvement in obstetrics and gynaecology requires particular consideration with regard to patient dignity and autonomy. This scoping review aims to explore the context of patient involvement in medical education of this specialty to date, with a view to identifying gaps in the current provision of training and amplifying the patient voice and perspective in an ethical way.MethodsA search was carried out across nine databases to identify studies pertaining to patient involvement in medical education in obstetrics and gynaecology. Studies from 1960 to 2025 were included. Patient involvement was categorised according to Towle’s “Spectrum of patient involvement”. Benefits to students from patient involvement were examined. Details regarding patient recruitment, consent, compensation and debriefing were recorded in order to ascertain the ways in which patient safety and wellbeing was cared for in each study.ResultsThe search identified fifty-three studies for final analysis. Most studies detailed patient involvement with regard to the demonstration and teaching of pelvic examination (n = 48). Few studies gave details on patient consent for participation (n = 12). The benefits to students from patient contact were clear with the majority of studies showing benefits (n = 51) in terms of either examination skills, empathy levels or interpersonal skills development. Few studies referenced patient training (n = 11) prior to participation or patient debriefing (n = 7).ConclusionTo date, patient involvement in medical education in this specialty has been largely confined to the demonstration and teaching of pelvic examination skills. Given the rich and diverse experiences of those seeking care in obstetrics and gynaecology, improvements could be made to place more emphasis on personal experiences and education delivered by patients themselves. Patient consent and respect for patient well-being should be of paramount importance in the context of any involvement in medical education. Future initiatives involving patients should ensure to explicitly define and outline how the protection, dignity and well-being of patients is ensured throughout their involvement in educational programmes.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12909-025-08091-w.

Disclosure: K.L. Yamamoto: None.Introduction: Mullerian agenesis occurs in roughly 1 in 4,500 to 5,000 females and typically presents as primary amenorrhea in female children. Its etiology is unclear, however patients with Mullerian agenesis are found to have hypoplasia or agenesis of structures derived from the Mullerian ducts, which include the upper vagina and the uterus. Other aspects of the female reproductive tract, such as the ovaries, are often structurally preserved and function normally leading to development of sexual secondary characteristics. Case: A 14 year old female presented to her pediatrician with complaints of amenorrhea and delayed development, with her exam notable for scant pubic hair but otherwise no development of secondary sexual characteristics including breast growth. Her initial labs denoted a hypergonadotropic hypogonad state, with an undetectable serum estradiol level and serum FSH and LH levels of 143.2 mIU/L and 62 mIU/mL respectively. Her other workup included a 46,XX karyotype, normal prolactin level of 16.1 ng/mL, TSH level of 2.09 mIU/L, total testosterone level of 29 ng/dL, a negative 21-hydroxylase antibody, a normal 17-hydroxyprogesterone level, and an anti-mullerian hormone level of less than 0.003 ng/mL. A pelvic ultrasound showed unusually small ovaries without any evidence of a cervix or uterus, with subsequent abdominal MRI showing no distinct follicle containing ovaries and the absence of a uterus and cervix. She was then referred to pediatric endocrinology, where she was given a diagnosis of Mullerian agenesis and started on escalating estradiol patch doses for puberty induction. She was counseled that fertility would be limited to in vitro fertilization with surrogacy. Roughly one year after initiation of estradiol, she began to note not only development of secondary sexual characteristics, but also monthly cyclical vaginal bleeding. A pelvic exam was performed where she was found to have a visible cervix and palpable uterus with follow-up ultrasound showing a uterus measuring 6.4 x 2.0 x 2.9 cm and a right ovary measuring 2.0 x 1.2 cm; her left ovary was not visualized. At this point, she was given a new diagnosis of 46,XX gonadal dysgenesis and started on monthly medroxyprogesterone acetate for endometrial protection.Conclusion: In a female patient with gonadal dysgenesis and resultant estrogen deficiency, initially compromised uterine growth can result in a uterus too small to see on imaging and a misdiagnosis of Mullerian agenesis until estradiol therapy is started, after which uterine growth can occur and subsequently be visualized.Presentation: Saturday, July 12, 2025

Automatic exposure control (AEC) is a device used in radiographic practice which terminates a radiographic acquisition when a certain exposure threshold is reached. The AEC is commonly utilised for in-bucky imaging, such as for the chest, abdomen, pelvis and spine. There are many benefits to utilising the AEC where awareness and knowledge of the technology are thoroughly understood. Poor technique when utilising the AEC, however, will alter dose, and by extension, image quality. This study aimed to assess how changes in patient positioning when using AEC for chest, abdomen, lumbar spine and pelvic x-ray examinations affect patient dose and image quality? An anthropomorphic phantom was marked every 1 cm from the ideal centring point in each direction; superior, inferior, left lateral and right lateral, for up to 5 cm of off-centring. Exposures were taken at each position and the tube current, air kerma and signal-to-noise ratios recorded for each exposure. Air-kerma changes ranged from a maximum reduction of 6.06%, 74.72%, 76.07%, and 35.66% for the chest, abdomen, pelvis and lumbar spine, respectively, to a maximum increased air kerma of 50.09%, 8.00% and 10.32% for the chest, pelvis and lumbar spine. The abdomen did not demonstrate any increased air-kerma results. Statistically significant changes (p < 0.05) to dose were observed in 54 of the 80 (67.5%) separate recordings. Changes to signal-to-noise ratio varied from a maximum negative change of 49.14% to a maximum positive change of 25.10%. Statistically significant differences in dose were commonly discovered for mis-positioning beyond 1-2 cm, which will likely occur within the clinical environment. Such variation in dose and signal-to-noise ratio identifies potential impacts to image quality and dose burdens to patients. The results highlight the need for careful consideration when using the AEC and the requirement for accurate positioning technique by the radiographer.

Limits On Vaginal Intercourse after Mid-urEthral Sling (LOVE): A randomized trial.

Informed consent laws allow patients to decide what happens to their bodies within a medical setting, but medical practices within academic teaching hospitals do not always live up to ethical standards or align with the values and wishes of clinicians, patients, and families. Bioethics often helps to resolve these conflicts through collaboration and dialogue. However, when conflicts persist and are resistant to change, it may be necessary to pursue regulatory or legislative solutions. This paper discusses the role of bioethics in strengthening federal regulations on explicit consent for sensitive (pelvic, prostate, rectal, and breast) exams. Since psychologists within academic health centers may also wish to influence policy, this paper concludes with practical, achievable guidance for psychologists to gain an understanding of the public policymaking process, develop relationships with policymakers, and take steps to exert influence on the policymaking process.

Comparison of vaginal stenosis following vault brachytherapy monotherapy between common fractionation schemes in the treatment of endometrial cancer.

There are scant pooled data on transgender individuals regarding pelvic floor dysfunction, with or without gender-affirming surgery (GAS). A scoping review following PRISMA-ScR guidelines was carried out using PubMed, EMBASE, Scopus, Web of Science, Cochrane Library, and Lilacs in June 2024. The following pelvic floor disorders were investigated: urinary and anorectal dysfunctions, pelvic organ prolapse (POP), sexual dysfunction and pelvic floor disorders after GAS. Of 1284 studies, 35 remained for full-text analysis and data extraction. Urinary dysfunction was seen within 10 studies and prevalence of urinary incontinence (UI) varied from 15.4 to 53%, with age, BMI, and depression identified as factors in these studies. Anorectal dysfunction was found in four studies and constipation was the most frequent complaint, varying from 22 to 45%. Constipation was the main anorectal complaint (22%-45.6%). POP rate after neovaginoplasty ranged between 4% and 7.5%. Regarding sexual dysfunction, the Female Sexual Function Index, was the most commonly used questionnaire. Sexual desire appears to be affected by gender-affirming hormone therapy, whereas lubrication and pain were altered in trans women (TW) patients. Sexual dysfunction rates in trans men (TM) were high (54%-87.8%). Regarding complications, most common findings were vaginal stenosis in TW and urethral strictures and fistulas in TM. There is a high prevalence of pelvic floor dysfunction among the transgender population. Future cohort studies with better defined instruments and standardized pelvic examinations are recommended.

Research has identified various drivers that have resulted in the over-medicalisation of pregnancy monitoring and birthing practices in Taiwan. Other women’s health concerns beyond reproduction, however, remain under studied. To address this gap, this study explored women’s and healthcare professionals’ experiences and perceptions of gynaecological care at Taiwanese healthcare facilities. Interviews were conducted with gynaecologists, obstetrics and gynaecology nurses, and women who had experienced a pelvic examination at a Taiwanese obstetrics and gynaecology department. A thematic analysis of their narratives demonstrates that pelvic examinations are underused for a variety of reasons driven by different actors, policies and conceptualisations of modern medicine and women’s health, many of which reflect those that contribute to an over-medicalisation of reproduction. This over-medicalisation of reproduction, together with the under-medicalisation of gynaecological health, reveals the extent to which women’s health is equated with reproduction in the Taiwanese healthcare system and wider society. This phenomenon poses risks to women’s health due to both excessive intervention in reproductive processes alongside the underdiagnosis and misdiagnosis of other health concerns unrelated to reproduction.

Background. Sex cord tumor with annular tubules is a rare ovarian pathology. Its incidence is only 6% of all primary ovarian neoplasms. The clinical signs of this disease are diverse and often individual. The major treatment option is surgery. Case description. Patient M., 12 years old, was admitted to the hospital with complaints on recurrent genital bleeding. Historical information: patient had suspected dermoid cyst of the right ovary according to ultrasound. The patient was readmitted to the hematology and chemotherapy department due to posthemorrhagic iron deficiency anemia. Next ultrasound has revealed solid mass in the structure of right ovary, 67 × 42 × 54 mm, with active blood flow. Preliminary diagnosis of “D39.1 Neoplasm of uncertain or unknown behavior: Ovary” was made upon admission to the hospital. The mass up to 7 cm in size, low-elastic consistency, painless at palpation has been revealed to the right of the uterus via bimanual examination. Thus, the preliminary diagnosis was confirmed. The tumor of the right ovary was sent for histological examination after its surgical removal. The pathologist concluded that the morphological picture corresponds to sex cord tumor with annular tubules. Oncologist has made the final diagnosis according to pathoanatomical examination: “C56 Malignant neoplasm of ovary”. The patient was suggested to perform additional examination and recommendations were given at discharge to clarify the disease stage and determine the indications for antineoplastic therapy. Conclusion. Regular admissions to gynecologist are crucial for teenage girls since many diseases can have subtle or no clinical signs.

State-level Contraceptive Access Policies and Preventive Sexual and Reproductive Health Service Use Outcomes.

This article examines the importance of analgesia during speculum exams in the emergency department (ED). As ED physicians, we can promote a comprehensive approach to pelvic examinations and advocate for peri-procedural analgesia for these patients. Emergency doctors should routinely inquire about women's needs and address them before the speculum exam. I discuss which populations may experience heightened pain and explore both non-pharmacological and pharmacological options for pain relief. There is a paucity of ED-based research addressing this issue, which urgently requires attention. Ensuring equitable access to analgesia is a fundamental clinical obligation.

Uterine fibroids are the most common benign tumor in women. Most fibroids are asymptomatic, but presenting symptoms include those associated with increased uterine size (eg, abdominal distension, urinary frequency or urgency, constipation), abnormal uterine bleeding, pelvic pain, and infertility. The initial evaluation of fibroids should include a full gynecologic history with abdominal, speculum, and bimanual pelvic examinations. Initial imaging of choice is the combination of transvaginal and transabdominal ultrasonography. Pelvic magnetic resonance imaging with contrast may further characterize the extent of disease and guide treatment. Treatment choices are determined by fibroid size and location with preferences for uterine and fertility preservation. Pharmacotherapy is used to control heavy or abnormal uterine bleeding and includes combined and progestin-only oral contraceptives; 52-mg levonorgestrel-releasing intrauterine devices; nonsteroidal anti-inflammatory drugs; tranexamic acid; and hormonal therapies, such as gonadotropin-releasing hormone antagonists and gonadotropin-releasing hormone agonists. Surgical and interventional options reduce bulk symptoms, reduce bleeding, and may preserve or improve fertility. Surgical and interventional radiologic options include hysterectomy, myomectomy, uterine artery embolization, radiofrequency ablation, and high-intensity focused ultrasonography. Treating vitamin D deficiency may reduce fibroid tumor size or halt progression.

Fostering Patient-Centered Trauma-Informed Care: Insights From a First-time Pelvic Examination

Introduction: Gastroschisis, a congenital abdominal wall defect, causes external protrusion of intestines and organs due to incomplete wall closure near the umbilicus. Accurate prenatal diagnosis through ultrasonography requires skilled operators to detect the defect and guide management. Early identification enables perinatal care planning to minimize complications, such as organ perforation, and optimize neonatal outcomes. This case report examines the prenatal diagnosis and management of gastroschisis in a primigravida, highlighting ultrasonography's role in clinical decision-making. Case Description: A 26-year-old primigravida at 34–35 weeks gestation was referred from Zubir Mahmud Regional Hospital with a prenatal diagnosis of gastroschisis. She reported severe abdominal pain and vaginal spotting for three weeks. Physical examination indicated stable hemodynamics, with obstetric findings including a fundal height of 26 cm, estimated fetal weight of 2015 g, left-sided fetal back, fetal heart rate of 142 beats/min, breech presentation, and no contractions. Speculum examination revealed a closed external cervical os, no dilation, negative fluxus, positive flour, protruding amniotic membranes, and a positive nitrazine test. Vaginal examination showed a posterior, soft cervix with no dilation or palpable fetal parts. The pregnancy was diagnosed with congenital gastroschisis, and a cesarean section was planned to prevent abdominal organ perforation. Conclusion: Gastroschisis, identified at 34–35 weeks gestation, necessitates early prenatal diagnosis to prepare for appropriate perinatal care. Cesarean delivery is a preferred strategy to reduce risks of organ damage, supporting improved neonatal outcomes in affected pregnancies.