Pelvic examination under anesthesia
- William J Mann, Jr, MD
William J Mann, Jr, MD
- Section Editor — Gynecologic Surgery
- Clinical Professor
- Department of Obstetrics and Gynecology
- Virginia Commonwealth University School of Medicine
Pelvic examination under anesthesia is performed when a patient cannot be adequately examined without sedation or general anesthesia (eg, for reasons of physical or psychological discomfort) or to provide information that will help guide a subsequent surgical procedure. In addition, clinical staging of cervical or vaginal cancer is performed under anesthesia.
Pelvic examination under anesthesia in adults is reviewed here. General principles of the gynecologic history and physical examination in adults and children, and of cervical cancer staging, are discussed separately. (See "The gynecologic history and pelvic examination" and "Gynecologic examination of the newborn and child" and "Invasive cervical cancer: Staging and evaluation of lymph nodes" and "Vaginal cancer".)
Informed consent is required prior to performing a pelvic examination under anesthesia (EUA) [1-3]. The surgeon should discuss with the patient the purpose of the EUA, as well as the personnel who will perform the examination (eg, surgeon, assisting surgeon, residents, medical students) . This discussion should be documented on the surgical consent form and in the medical record. This applies whether the EUA is used solely or in part for the purpose of teaching medical students or trainees.
In addition, the surgeon should discuss the possibility that a finding on examination may change the surgical approach or the extent of the procedure. The patient should be counseled about potential changes and consent or decline preoperatively to changes in the procedure.
GOALS OF THE EXAMINATION
Determination of the axis and length of the cervix and the size, position, mobility, and descent of the uterus just prior to a procedure provides the following benefits:
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