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Sequence of Pelvic Examination Affects Patient-Reported Pain
Journal article   Peer reviewed

Sequence of Pelvic Examination Affects Patient-Reported Pain

Rebecca Rinko, Ian Yu, Emna Bakillah, Lauren Alper, Colleen Delaney, Marisa Su, Melissa Dawson, Edward J Gracely and Kristene E Whitmore
Female pelvic medicine & reconstructive surgery, v 24(2), pp 150-154
01 Mar 2018
DOI: https://doi.org/10.1097/SPV.0000000000000515
PMID: 29474289

Abstract

OBJECTIVEThe purpose of this trial is to compare patient-reported pain based on the sequence of the pelvic examination and to assess the relationship between pain during the examination and quality of life, self-esteem, and sexual function.METHODSA randomized controlled trial of women presenting for annual gynecologic examinations. Women were assigned to either group A: a Q-tip touch test, speculum examination, then bimanual examination or group B: Q-tip touch test, bimanual examination, then speculum examination. The primary outcome was visual analog scales to assess pain at baseline and after each portion of the examination. Secondary outcomes were responses to questionnaires for self-esteem, quality of life, and sexual function.RESULTSOf 200 women who enrolled, 192 (96%) completed all visual analog scale data points. Each portion of the examination caused minimal pain over baseline in each group. Pain during the speculum examination was higher than pain during the bimanual examination in both groups (P = 0.007 and P < 0.001). Group B, however, had significantly higher pain scores after the speculum examination than group A (P = 0.044). The groups did not differ on bimanual pain scores (P = 0.76). Pain scores were not statistically different when analyzed by age, parity, sexual activity, sexual orientation, education, or previous hysterectomy. Within both groups, patients who documented having any pain after the speculum examination or the bimanual examination were also more likely to have lower quality of life scores (P < 0.001 and P < 0.001).CONCLUSIONSPain associated with the speculum examination was lower in those undergoing speculum before bimanual examination. Speculum pain was greater than bimanual pain in both groups. Most patients reported minimal or no pain during the different portions of the examination.

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Obstetrics & Gynecology
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