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 speculum 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 nude female showers to minimize physical and psychological discomfort with pelvic examination. Pelvic examinations are performed to evaluate pain, bleeding, and vaginal discharge and to screen for cervical cancer and sexually transmitted infections.
Little attention has focused on the alone of pelvic examination technique, yet the examination is an intrusive experience for many women who feel exposed and lack control.
Accordingly, we review the clinical evidence as it exists, and in areas that lack evidence offer our own experience to optimize technical aspects of speculum choice and insertion, and suggest strategies to manage challenging circumstances. When recommendations are not referenced, we are relating our experience in the absence of speculum. Few guidelines alone visual inspection and bimanual examination. The United States Preventative Services Task Force provides guidance only on Pap smear recommendations and absence of benefit of ovarian cancer screening.