Physical Exam Techniques to Support and Promote Women’s Health

National Women’s Health Week, which occurs annually beginning on Mother’s Day, brings focus to women’s health. Women have unique health needs—related to pregnancy, menopause and more—and are also disproportionately impacted by other conditions, such as osteoarthritis and urinary tract problems. Data also shows that women are biologically more susceptible to certain sexually transmitted infections than men and are also more likely to be diagnosed with these conditions. Fortunately, outcomes related to women’s health conditions can often be improved with early detection and careful monitoring. Physical exams play an important role in this process, so we’ve compiled resources and information related to women’s health for physicians and medical learners.

What the Numbers Say

According to the Institute for Women’s Policy Research, women’s health has improved in some categories and declined in others over the years. For example, the mortality rates related to breast cancer have dropped since 2004 and the incidences of AIDS have also decreased. However, incidences of diabetes and chlamydia have increased.

Recent data reveals some startling statistics:

·      Approximately 810 women die every day from preventable causes related to pregnancy and childbirth, says the World Health Organization.

·      About 13% of U.S. women will develop invasive breast cancer in their lifetime, according to BreastCancer.org.  

·      The American Cancer Society estimates that 65,950 new cases of cancer of the body of the uterus will be diagnosed in 2022.

The Pelvic Exam

The pelvic exam is a critical part of women’s preventive care and can help diagnose a variety of conditions, particularly those related to abdominal or pelvic complaints. In our guide to the pelvic exam, we discuss types of speculums, how to prepare the patient, abdominal palpation, vulvar and speculum examination and more.

Video Demonstration of the Pelvic Exam

Physician Tips for the Pelvic Physical Exam

·      Have the patient empty their bladder before the exam.

·      Be sure to keep the following tools on hand: Speculum, lubricant, light source, materials for wet mount, pap smear or STD testing.

·      In hospitalized patients, an exam table with leg rests is often not available. If a speculum exam is needed immediately, it can be helpful to place an inverted bedpan underneath the patient’s buttocks to elevate the pelvis.

·      Speculums can be cold! It’s important to keep these in warmer temperatures or run them under water prior to use. Touch the speculum onto patient’s thigh to see if the temperature is appropriate.

·      If you’re working with a patient with a history of trauma, ensure that the patient knows they are in control and can stop the exam at any time.

The Breast Exam

Common presenting complaints of breast disease are self-detected masses or pain. Knowing the proper technique for the breast physical exam, which includes inspection, palpation and the lymph node exam, can help physicians better discriminate between benign and malignant lesions. Our guide details important observations, patient positioning instructions, inspection maneuvers and more.

Video Demonstration of the Breast Exam

Physician Tips for the Breast Exam

·       It is advisable for male examiners to have a female chaperone assist during the examination.

·      Avoid performing a breast exam right before the beginning of menstruation, when benign lesions may be bigger and more painful, which can make it difficult to discriminate between benign and malignant masses.

·      Don’t forget to wash your hands before and after the exam!

·      We recommend removing exam gloves before palpating the breasts. Wearing gloves may reduce your ability to fully appreciate all the features of a lesion, especially the smallest ones.

·      When palpating the breasts, we recommend using the finger pads rather than the finger tips. It is also helpful to use one hand to stabilize the breast while the other palpates for abnormalities.

·      Use the opportunity to educate patients on the process for a proper self-exam.

Don’t forget to check out our blog on memorable metaphors and pathognomonic signs that relate to the gynecologic exam. For example, during a pelvic exam, uterine size can be likened to fruits, such as a pear or grapefruit!

Visit our website for more information on physical exams and Stanford Medicine 25’s mission to promote the culture of bedside medicine.