T he Pe r fe c t Pe lvic E xam NPO c o nfe re nc e 2018 Ja - PowerPoint PPT Presentation

T he Pe r fe c t Pe lvic E xam NPO c o nfe re nc e 2018 Ja c q ue lyn Que ta l, F NP-C

“Jac qui, do you have any disc losur e s?” No pe

Obje c tive s  Disc uss c ha lle ng e s a s a g ro up  Unde rsta nd ho w to g a in c o nse nt a nd ho w/ whe n to tra nsfe r po we r to the pa tie nt  Re think pa tie nt po sitio ning te c hniq ue s  Avo id trig g e ring to uc h, wo rds a nd la ng ua g e  Co nte xtua lize with so me c a se studie s

T e ll me your fe e lings about pe lvic e xams… Disc uss pro s a nd c o ns

Why do we do the m?  Da ta c o lle c tio n--PAP, we t mo unt, ST D te sting  I UD inse rtio n o r re mo va l  Annua ls  We we re tra ine d to b e tho ro ug h  We think it impro ve s pa tie nt sa tisfa c tio n

Wha t a re the g uide line s?  PAP sta rt a g e 21, q 3 ye a rs  Co te st a t 30 a nd o lde r, q 5 ye a rs  I f pre se nting with pro b le ms, e xa mine  Pe lvic pa in, a b no rma l b le e ding , infe c tio n c o nc e rns.  Bima nua l fo r I UD inse rtio n  Do a ny o rg s re c o mme nd spe c ific ye a rly pe lvic e xa m?

T he how  Sta te the purpo se o f the e xa m a nd wha t c a n b e g a ine d  Ask/ inte rvie w whe n c lo the s a re o n if po ssib le  Ge t c onse nt  Wa lk the m thro ug h the pro c e ss  L e t the m kno w the y c a n sto p  Ge t the m into po sitio n  Na rra te a lo ng the wa y  Che c k in whe n do ne  De b rie f if ne e de d

Wha t is powe r tra nsfe r? 1 2 3 4 Whe n we a sk o pe n Whe n we sa y it’ s Whe n we le t a Whe n yo u le t he r e nde d q ue stio ns OK not to ha ve a pa tie nt do a se lf ma ke a de c isio n a nd truly c a re wha t pe lvic e xa m. swa b / pla c e the ir a b o ut ho w to c o me s o ut o f the o wn spe c ulum. ma ke the e xa m pa tie nt’ s mo uth. mo re c o mfo rta b le .

 Chla mydia a nd g o no rrhe a te sting T o se lf swa b or  We t mo unt  Re c ta l swa b s not?  HPV sc re e ning

Disc ussing a na tomy  Use la ng ua g e the pa tie nt use s  Ask b e fo re yo u sta rt  T e a c h a s yo u g o  Give c o mplime nts a nd re a ssura nc e s

T rig g e r words  Re la x  L ie b a c k  Spre a d  Be d

T rig g e ring a c tions  Sq uirting g e l/ lub e o nto the skin  L ing e ring to uc he s  Mind yo ur thumb / to uc hing the c lito ris

Othe r c ha lle ng e s?  Hx o f a b use / tra uma  F irst pe lvic  L a rg e b o die s  Pe o ple who ha ve le ss fle xib le b o die s  T ra ns fo lks  Pe o ple who ha ve ha d va g ina l inte rc o urse b ut do n’ t a nymo re (o r o fte n)  Sc a re d/ a sha me d/ e mb a rra sse d pa tie nts

Spe c ulums…

T he e xa m

T ime to pr ac tic e Che c k o ut yo ur ha ndo uts

One mor e thought… I f yo u do find so me thing unusua l…

Ca se study #1  17 ye a r o ld fe ma le  Va g ina l disc ha rg e a nd o do r  No c urre nt se xua l pa rtne r, b ut hx o f 2 ma le pa rtne rs in the la st 12 mo nths  L MP 2 we e ks a g o , no rma l b le e ding , no t pa inful  Wha t te sts do we ne e d?  Do we ne e d a pe lvic e xa m?

Ca se study #2  30 y/ o fe ma le  Mutua lly mo no g a mo us re la tio nship with ma le pa rtne r  L a st pa p wa s 2 ye a rs a g o , no rma l re sult c yto lo g y a nd no re fle x to HPV  Asympto ma tic  Using I UD suc c e ssfully  Do e s she ne e d a ny te sting ?  Pe lvic e xa m?

Ca se study #3  24 ye a r o ld tra ns ma le  Ne ve r ha d a pa p o r pe lvic e xa m  Asympto ma tic  Wha t e lse do we ne e d to kno w?  Do we ne e d to do a pe lvic e xa m?

T hank you for be ing he r e ! jq ue ta l@ king c o unty.g o v

Re fe re nc e s  ACOG. (2017) Pra c tic e Ad viso ry; Sc re e ning Pe lvic E xa mina tio n. https:/ / www.a c o g .o rg / Clinic a l-Guid a nc e -a nd -Pub lic a tio ns/ Pra c tic e - Ad viso rie s/ Pra c tic e -Ad viso ry-Sc re e ning -Pe lvic -E xa mina tio n.  Bro o ks Ba rr, W. (2006). Va g ina l spe c ulum e xa mina tio ns witho ut stirrups. BMJ . 333(7560): 158–159. https:/ / www.nc b i.nlm.nih.g o v/ pmc / a rtic le s/ PMC1513505/  Guirg uis-Bla ke JM, He nd e rso n JT , Pe rd ue L A. Pe rio d ic sc re e ning pe lvic e xa mina tio n: e vid e nc e re po rt a nd syste ma tic re vie w fo r the U.S. Pre ve ntive Se rvic e s T a sk F o rc e . JAMA. 2017;317(9):954-966.  Pe te rse n, H.N. e t a l. (2018). Imple me nta tio n c o nsid e ra tio ns using HPV se lf-c o lle c tio n to re a c h wo me n und e r-sc re e ne d fo r c e rvic a l c a nc e r in hig h-inc o me se tting s. Curr Onc . 25 (1). https:/ / www.nc b i.nlm.nih.g o v/ pmc / a rtic le s/ PMC5832289/  Ra vi, A., L ittle , V. (2017). Pro vid ing T ra uma -Info rme d Ca re . Am F am Physic ian. 95(10):655-657. https:/ / www.a a fp .o rg / a fp/ 2017/ 0515/ p655.html  Re pro d uc tive He a lth Ac c e ss Pro je c t. (2015). Co ntra c e p tive Pe a rl: T ra uma Info rme d Pe lvic E xa ms. https:/ / www.re pro d uc tive a c c e ss.o rg / re so urc e / tra uma -info rme d -pe lvic -e xa ms/  T illma n, S. (2016). E mpo we ring Gyne c o lo g ic E xa ms: Spe c ulum Ca re Witho ut Stirrups. http :/ / www.fe ministmid wife .c o m/ 2016/ 11/ 02/ e mpo we ring -g yne c o lo g ic -e xa ms-spe c ulum-c a re -witho ut-stirrups/ # .WyM9q S_Myu4  US Pre ve ntive Se rvic e s T a sk F o rc e Re c o mme nd a tio n Sta te me nt. Sc r e e ning for Gyne c ologic Conditions With Pe lvic E xamination. JAMA. 2017;317(9):947-953. https:/ / ja ma ne two rk.c o m/ jo urna ls/ ja ma / fulla rtic le / 2608228