title: The challenging pelvic examination.
abstract: 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.
authors.affiliation: Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA, USA. cbates@bidmc.harvard.edu
authors.forename: Carol K
authors.initials: CK
authors.lastname: Bates
authors.forename: Nina
authors.initials: N
authors.lastname: Carroll
authors.forename: Jennifer
authors.initials: J
authors.lastname: Potter
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D005260:Female; D058869:Gynecological Examination / Q000379:methods* / Q000523:psychology / Q000592:standards*; D006801:Humans; D065006:Papanicolaou Test; D010353:Patient Education as Topic / Q000379:methods / Q000592:standards; D012725:Sexual Behavior / Q000502:physiology; D012749:Sexually Transmitted Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology; D014626:Vaginal Smears / Q000379:methods / Q000592:standards