Key Feature 3c: In a woman with abdominal pain: Do a pelvic examination, if appropriate.
Skill: Clinical Reasoning
Phase: Physical, Diagnosis
In my last blog post I described my encounter with a 27 year old female patient presenting with abdominal pain. The cause of her pain was ultimately felt to be a combination of a flare-up of ulcerative colitis along with secondary acute opioid withdrawal. But during my first assessment of her, and with pain that she localised to her right lower quadrant, I had to consider that there was a gynecological etiology contributing to her pain. (As a female of childbearing age, this would be indicated regardless, but on top of that, she had significant risk factors including past history of a ruptured ovarian cyst and pelvic inflammatory disease.) A pelvic examination was warranted as part of this patient's workup, and my findings were reassuring in that there were no specific signs of gynecological pathology on exam.
My approach to a general pelvic examination is as follows: