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My first pelvic/breast exam

Discussion in 'Ob/Gyn' started by cableguy, Jun 4, 2008.

  1. cableguy

    cableguy PA-C 5+ Year Member

    Sep 30, 2007
    U.S. of A.
    Well I just completed my first genital/rectal exam on a pt-model yesterday. It was a little nerve wracking but not as bad as I anticipated.

    However, in two weeks we use pt-models to complete our first breast/pelvic exams. I'm a little apprehensive because it seems that a pelvic exam requires a lot more skill/technique/finesse. Especially while trying to manipulate a speculum.

    Any advice would be greatly appreciated...

    Thanks in advance,

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  3. Global Disrobal

    Global Disrobal Along for the ride Moderator Moderator Emeritus 10+ Year Member

    Sep 24, 2002
  4. cableguy

    cableguy PA-C 5+ Year Member

    Sep 30, 2007
    U.S. of A.
    Thanks Global. That was a great thread regarding speculum technique. I will be sure to pass it on to my classmates.

    Does anyone have any general advice to approaching a breast/pelvic exam?

    I wouldn't mind learning from your mistakes, epiphanies, or awkward moments...;)

    thanks again,

  5. Trillgirl

    Trillgirl Scut Princess 7+ Year Member

    What NOT to say...

    1. "First, let me look at your breasts." (inspect, don't look)

    2. "I'm just going to feel your breasts, now." (examine, don't feel)

    3. "Everything feels good." (meant to be encouraging)

    Obviously, jokes aside, be careful about the double entendre of some comments you may make quite innocently.

    When I do a bi-manual exam I usually tell my patients that I am going to do an "internal exam". It sounds somewhat less invasive than bimanual or digital.

    Don't rush but don't drag either. That's what usually ends up hurting a patient. Think about getting a DRE. You wouldn't want someone "shoving" their finger(s) anywhere, right? And if they say "you're hurting me" believe them. Stop. Assess if it is pain or just pressure/discomfort and if needed, start all over again.

    All this stuff is just common sense... you'll be fine.
  6. Strength&Speed

    Strength&Speed Need more speed...... 10+ Year Member

    Dec 26, 2004
    sorry, wrong thread
  7. MaddieMay

    MaddieMay 2+ Year Member

    Feb 25, 2008
    From a pt. perspective, this is what I really like when I'm see a doc I haven't seen before.

    1. Once the feet are in the stirrups, say, "Just take some deep relaxing breaths"

    2. "You're going to feel my finger on your leg, " (mid-inner thigh), then move your hand closer.

    3. Before you use the speculum, "Now in a second here, you're going to feel something cold."

    4. "You're doing fine" and "Almost done" are music to my ears.

    I also have a question. Are pts stinky feet more bothersome than... let's say other parts?
  8. chrisisinnocent

    chrisisinnocent Elbow deep 7+ Year Member

    Mar 30, 2006
    New York City
    I have never noticed this. Also, given what I have seen and smelled so far nothing really bothers me smellwise.
  9. MaddieMay

    MaddieMay 2+ Year Member

    Feb 25, 2008
    Good to know. As a pt, I never want to incite disgust in my doc, via stinky anything,

    Any other opinions?
  10. Winged Scapula

    Winged Scapula Cougariffic! Staff Member Administrator Physician Faculty Lifetime Donor Classifieds Approved 15+ Year Member

    Apr 9, 2000
    hSDN Member
    I've smelled some pretty revolting things in my career, and feet and "other parts" have not been in the top ten most disgusting.

    Its mostly the necrotizing fasciitis and infected wounds that get me. Patients apologize to me everyday for sweating during their exam, or not shaving. If they only knew what I've seen, they'd realize that I barely notice these things anymore. :scared:
  11. smq123

    smq123 John William Waterhouse Administrator Physician SDN Advisor 10+ Year Member

    Jan 9, 2006
    For me? Yes.

    Personally, nothing beats diabetic feet. The smell just gets into my nostrils and stays there. :barf:

    (Some people actually really can't take eyes. Watching surgery on the eyes bothers them more than any pelvic or any foot exam.)
    Last edited: Jun 8, 2008
  12. Trillgirl

    Trillgirl Scut Princess 7+ Year Member

    I admit it - eyeballs totally gross me out. The thought of doing or seeing eye surgery... eeeeewwww.

    I don't care if you've shaved or not. I don't care if you're sweaty. But yes, I do sorta mind stinky feet. I'll never tell you that, though. Not very kind, and not important for a 45 second exam.
  13. Rendar5

    Rendar5 10+ Year Member

    Nov 12, 2003
    to the OP, as for technical aspects, don't worry too much, they'll instruct you well. only tips to mention that I've foudn useful are that anterior parts of the vagina are more sensitive than posterior, so keep pressure directed towards the back and go in at a 30-45 degree angle pointed downward. vaginas don't go superior-inferior anyway. they're obliqueish structures.

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