The first pelvic exam

I’m going to quote something from the manual I have on pelvic examinations –

“…you will also rotate through a station with the prosthetic model and, if time permits, practice performing a pap smear…”

It’s not the idea of performing the pap test that strikes me as funny, rather it’s the idea that there are prosthetic models designed for this. In reality, it is more than a little disconcerting to walk into a room with 6 or more disembodied women’s pelvis’ ready for inspection. As a “professional” I had to act as though this was normal, that at any given time on any given day I am expecting to find a bunch of prosthetic pelvis’ which require a pap smear. No sense of surprise, no smile and nothing other than pure professionalism is to be expressed. So my day begins – it’s 8 am and my clinical skills class is in full swing.

The obs/gyn doctor stands at the back and asks me questions as I struggle through the examination. “What structures are you observing? Why is the cervix blue in this model and pink in the other? What are the characteristic differences between a cyst palpated internally and cancer?” I’m sweating, answering the questions the best I can and apologizing profusely to the prosthetic torsos for some reason. The speculum is not a nice looking instrument and I am not handling it with any particular grace or skill. I guess I think I may be causing some discomfort to the inanimate object in front of me. And then it’s done. I am now an expert ready to perform a pelvic whenever required.

Then it comes time to demonstrate the pelvic exam technique on one of the Clinical Teaching Assistants (CTAs) present. I should clarify here that the CTAs in this case act as both the ‘patient’ and ‘tutor’. This is brilliant. I now have the opportunity to offend my tutor in a way that I could not have imagined before this moment. I am very lucky to have this opportunity but it is, none the less, awkward. I have never done a pelvic examination before on an actual living, breathing woman, be it instructor or otherwise. This is better, I suppose, than my first time being with some luckless patient and I am glad that the experience is in this controlled environment. Some of my peers have been through this already and they warn me – watch what you say (“looks good” and “pull out” are on the list of things not to say), but most of all watch where you put your thumb …

Looking for some technical information on pap smears? … Try this link from the Alberta Cervical Cancer Screening Program …

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3 responses to “The first pelvic exam

  1. Oh boy, the first time I did a pelvic exam, I was sweating like I’ve never sweat before. We were in groups of about 7, and among the “patient,” the attending, and my fellow classmates, I was the only male. And so, in a long-sleeve shirt, tie, white coat, and plastic gloves, I probably lost about 5 pounds in water weight in the 15 shaky minutes that it took me to palpate ovaries. Quite embarrassing.

  2. Thanks BFD – I was actually pretty lucky in the sense that there were only three of us in the group, four if you count the CTA. I think the women had a much harder time for some reason…at least the first one did. As she progressed through the exam she began to blush becoming this brilliant shade of red by the end. I felt bad for her… until it was my turn to do the exam and then the sympathetics kicked in.

  3. I just did mine today! First time as well, and was very nervous about it. At least it was just me and 2 other observers, so it wasn’t too stressing. But just getting exposed to this thing suddenly…. It was a massive shock! And bimanual palpation. I can say it was a unique experience.

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