Pelvic Examination of the Adolescent Patient
Remember
The lithotomy position is uncomfortable both physically and psychologically. Be professional, patient, and gentle. "Endearing" names for the patient like "honey" or "darlin", though used by some gynecologists, are inappropriate, especially for the adolescent. Explain ahead of time that the exam, though uncomfortable and embarrassing, should not hurt, and you will stop if it does.
Order of Tests
- External genitalia inspection
- Insertion of vaginal speculum and identification of cervix (Stay away from the urethra and anterior vaginal wall; downward pressure on the perineal body during insertion is often helpful)
- Swab cervix clean (if necessary)
- Endocervical swab for GC culture and endocervical portion of Gram stain slide
- Endocervical brush for Chlamydia FA and for endocervical component of PAP smear
- Wooden spatula for ectocervical portion of PAP smear
- Cotton tip swab of vaginal secretions in posterior fornix for NX Prep, KOH Prep and other portio of Gram stain slide
- Inspect vaginal wall as you retract the speculum
Bimanual Exam
- Identify cervix with intravaginal gloved examining fingers that have been first covered with sterile lubricant.
- Assess size and position of uterus using intravaginal examining fingers and abdominal hand
- Feel adnexal structures bilaterally
- Rectal exam only if indicated.
Give the patient tissues or washcloth to clean away the lubricant. Examine slides while your patient is getting dressed. Then discuss the results, your diagnosis, and recommended treatment with her privately after she is dressed.