Here is a serious question:
What truly is the utility of the Vagixam? We the housestaff end up having to do a pelvic on any vag complaint, but as far as I can tell it never really changes management. Yesterday, my boss didnt believe that I felt CMT and made the poor woman go through speculum exam number 2, and then we consulted GYN who Im sure gave her exam number 3.
You do pelvic exams on lower abdomina pains, or on vaginal complaints to
First: See if there is adnexal tenderness. If I have a patient whose history is consistent with ovarian pathology, or appendicitis, or diverticulitis, I do a pelvic and tend to do decide on imaging. If their tenderness is more on palpation of the adnexa, I tend to get ultrasound. If their tenderness is more on palpation of the external abdomen, (and they aren't pregnant), I tend to go for CT.
Second: To screen for GC/Chlamydia- Patients might not have discharge or cervical motion tenderness, but might end up being positive for these pathogens 2 days later. It is poor form to not pick-up these pathogens and increase your patient's risk of developing abscess, or infertility.
Third: To screen for trichomonas and yeast- these pathogens will significantly alter your antibiotic choice (If you end up treating for PID in the ER). PID with trich needs flagyl too. You want to be careful about giving antibiotics to a yeast infection as the patient will just get worse.
Fourth: To change your threshold for treating for PID, GC/Chlamydia. PID is a spectrum of disease and is more of a clinical diagnosis in the end. If I have a young girl, with abdominal pain, and complaints of vag discharge, and recent unprotected sex with a new partner, I will probably treat her no matter what, even if the exam is benign. If I have a 40 year old lady, who is at low risk for STDs, but I do a pelvic and she has raging cervical motion tenderness, and lots of clue cells, I'm going to assume that her husband is cheating and treat her for GC/Chlamydia, and PID, whereas, I would have sent her home with a shoulder shrug and "Don't know what you've got" if the exam had been normal (providided I didn't find any other reason in imaging or labs).
Keep in mind, you can have Fitz Hugh Curtis present as isolated RUQ pain, and you will never think of it, or properly diagnose it unless you do a pelvic. No I don't do pelvics on all RUQ, nor am I suggesting that, but in that vague abdominal pain, with worse symptoms in the RUQ, I might ask some social questions to assess the risk of STDs, and do a pelvic if they are at risk.
Did that answer your question?
I was just wondering if anyone has actually done this, and how you handle the aftermath. Do you apologize? Does the patient apologize? Does everyone pretend the room doesn't smell like death.
