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:To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- ACOG Committee on Ethics. ACOG Committee Opinion No. 358: professional responsibilities in obstetric-gynecologic education. Obstet Gynecol 2007; 109:239.
- Wainberg S, Wrigley H, Fair J, Ross S. Teaching pelvic examinations under anaesthesia: what do women think? J Obstet Gynaecol Can 2010; 32:49.
- York-Best CM, Ecker JL. Pelvic examinations under anesthesia: a teachable moment. Obstet Gynecol 2012; 120:741.
- Wilson RF. Unauthorized practice: teaching pelvic examination on women under anesthesia. J Am Med Womens Assoc (1972) 2003; 58:217.
- Ozaksit G, Caglar T, Zorlu CG, et al. Chronic pelvic pain in adolescent women. Diagnostic laparoscopy and ultrasonography. J Reprod Med 1995; 40:500.
- Padilla LA, Radosevich DM, Milad MP. Limitations of the pelvic examination for evaluation of the female pelvic organs. Int J Gynaecol Obstet 2005; 88:84.
- Padilla LA, Radosevich DM, Milad MP. Accuracy of the pelvic examination in detecting adnexal masses. Obstet Gynecol 2000; 96:593.