Introduction:

In this module we will describe an approach to people you may encounter in your practice with an aim to provide comprehensive evidence-based care that takes into consideration an inclusive approach. Life experiences and inflexible examination rooms may make the gynecological assessment uncomfortable for some patients. This module provides some examples and suggestions for providing holistic care.

Part 1: Pelvic Exam Considerations- Hesitancy, Anxiety, History of Trauma

The purpose of the pelvic exam is to check the size and position of organs, determine the underlying cause of pain, abnormal bleeding or discharge, screen for cervical changes including cancer and dysplasia (pap tests), screen for infectious pathology including sexually transmitted infections (STIs), and facilitate placement of birth control devices (diaphragm, intrauterine devices). While the pelvic exam is an important assessment tool related to everyday practice, for many patients the pelvic exam can be a vulnerable and distressing procedure.

This presentation will address factors that influence hesitancy, anxiety and triggers as a result of previous trauma. The presentation aims to heighten the practitioner’s awareness of aspects of the procedure that can be triggering and provide options to assist with optimizing comfort and minimizing distress.

Part 2: Pelvic Exam Considerations- Differently Abled

While the pelvic exam is an important assessment tool, for many individuals, who are differently abled, there can be significant physical or psychological barriers to accessing care. Providers can be inadequately informed and/or trained to facilitate access. This can leave patient feeling intimidated, limited, frustrated and vulnerable, and could ultimately delay access to acute care or screening health care.

This presentation will address factors that are barriers to access to care for persons with physical, visual and auditory challenges. The presentation aims to heighten the practitioner’s awareness to aspects of the procedure that can be a barrier and provide suggestions/options that will assist with optimizing accessibility to the pelvic exam for these populations.

Part 3: Pelvic Exam Considerations- 2SLGBTQI+

While the pelvic exam is an important assessment tool, for many patients in the 2SLGBTQI+  community, the pelvic exam can be a triggering, dysphoric and/or distressing procedure.

In order to support gender-affirming patient-centred care, providers need to provide a welcoming space. The also need to use appropriate language that promotes inclusivity, and take into consideration evidence-based approaches that optimize these important health assessments. Finally, they should strive to maximize physical and emotional comfort for individuals from the 2SLGBTQI+ community.

Objectives:

By the end of this module, learners will have increased awareness of and be able to optimize the comfort of the pelvic exam and health assessments as a result of achieving the following objectives:

Part 1: Pelvic Exam Considerations: Hesitancy, Anxiety, History of Trauma

1. Review factors that influence hesitancy and anxiety
2. Discuss pre-examination options to facilitate support
3. Discuss options to optimize comfort: voiding bladder, alternative positioning, speculum choice, temperature and lubrication options
4. Discuss considerations for previous trauma (physical or sexual)
5. Discuss female genital cutting and mutilation and practitioner responsibilities
6. Discuss virginity testing and confirmation, and practitioner responsibilities

Part 2: Pelvic Exam Considerations Differently Abled

1. Review factors influencing pelvic exams hesitancy
2. Review preparations for the pelvic exam for a person differently abled
3. Discuss considerations: exam tables, positioning, incontinence
4. Discuss considerations related to referrals for: spinal cord injury, differently abled vision, differently abled hearing, differently abled cognition

Part 3: Pelvic Exam Considerations for 2SLGBTQI+

1. Increase awareness of the RNAO Best Practice Guidelines: promoting 2SLGBTQI+ health equity
2. Review terminology and appropriate language use
3. Discuss considerations for:
   • Taking a Sexual & Gender History
   • Pelvic Exam
   • Transmasculine Persons (Canadian Cancer Society Recommendations)
   • Transfeminine Persons (Canadian Cancer Society Recommendations)
   •  2SLGBTQI+ (with a cervix) & women who have sex with women (Canadian Cancer Society Recommendations)

Pre-Module Quiz: