How Should a Physician Respond to a Patient’s Unexpected Pain During a Pelvic Examination When There Is Clinical Indication of Infection?
Year: 2025
Type: article
Abstract: This commentary on a case considers how to navigate a pelvic exam in the context of a patient's personal experience and suggests the clinical and ethical importance of thoughtful, intentional action and consistent, clear communication in these clinical encounters.Case Dr B sees CC, who is 16 years old and presents with persistent, foul-smelling vaginal discharge despite finishing antibiotics prescribed by another clinician for a presumed sexually transmitted infection (STI).Dr B explains, "I need to perform a pelvic examination and get a swab sample for the lab to test.Do you understand what that means?"CC responds, "Yes," and nods agreement.Dr B returns with a chaperone.Upon inserting and opening a lubricated speculum in CC's vaginal canal, CC screams, "This hurts too much!"Dr B slowly withdraws the speculum and does not complete the examination.Given CC's recent health history, Dr B needs an accurate diagnosis to inform appropriate treatment."Maybe I should have just quickly inserted the swab to get a sample," Dr B wonders.Commentary Pelvic exam is used as an umbrella term for one or more potential evaluations: cervical cancer screen, STI screen, speculum exam, bimanual exam, visual inspection, and more. 1 However, patients-especially patients of color-might associate a pelvic exam with anxiety, fear, discomfort, and pain.1,2,3 Throughout history, people of color and vulnerable populations have been used gynecologically to advance the goals of others: from Dr J. Marion Sims, lauded as the "father of modern gynaecology," who performed pelvic surgeries on slaves without analgesia despite its availability, 4 to physicians threatening to withhold medical care unless people were sterilized and legislative proposals that financially incentivize women of low income to choose contraceptive implants.5,6 Patients bring experiences of not only systemic racism but personal trauma to the exam room.7 In surveys of predominantly White and of diverse adult respondents, 64% and 83%, respectively, reported having experienced at least one category of adverse childhood experiences, including sexual abuse.7 Examinations can trigger
Source: The AMA Journal of Ethic
Authors: Kelsy Schultz, Charita L. Roque
Institution: Western Michigan University
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4407088466