Friday, January 7, 2011

Now You Feel It!

This semester really hit us fast and hard. I was (and still am) unprepared. And before you proceed with reading the rest of this post, steel yourself; because you see, we just learned how to do a female pelvic exam. Proceed with caution.

It's definitely something that I'm sure many of you reading now will never have the "pleasure" of experiencing (because you're guys and likely gay/bi). I can't say that I blame you. The female pelvic exam is one that every med student is uncomfortable and nervous about the first time. But, after actually doing it (and seeing it done 5 times before I did it), I can confidently say that it's not that bad - as long as you're aware of a few things.

One, know the planes of the female anatomy. See, here's a cross-section picture from Netter's Atlas of Human Anatomy:

And here's the same picture turned 90 degrees:

A few things to notice: 1.) the uterus points "up" towards the belly/ceiling, 2.) the vagina tilts "down" towards the floor, and 3.) the bladder is in front of the vagina and uterus. All of this is critically important.

Two, be ever conscious of everything you say. Never say "oops" or "I think." Those are key words to get you kicked in the face while you're down there.

Three, go slow and be careful! This is one exam where you can actually hurt a patient. And you see, because the vagina is tilted down, you don't insert the speculum straight in but angle it down as you go.

Four, the cervix, uterus, and ovaries aren't "fixed" in place and can move about a little inside the body. That can make finding things a tad tricky . . .

Okay, with those 4 points in mind, the pelvic exam! Our volunteer patient wasn't the "ideal" patient as she was heavier, older (post-menopausal), and had something called a "retroflexed" uterus where instead of pointing "up" it curled over and pointed down. BUT she was an amazing patient otherwise. I also got stuck holding the speculum for everyone. -_-

The exam is pretty straightforward. First examine the external genitalia. I don't know what the big deal is, but the clitoris actually isn't hard to find. Then do the speculum exam, keep in mind the points above. All that was the easy part.

Now, the harder part (IMO) is the bimanual exam, where you stick 2 fingers into the vagina, have your fingertips behind the cervix, and push "up" so that the uterus bumps up against the abdominal wall. I was skeptical about being able to feel the uterus (and especially the ovaries). Because I was the last of 5 students to go, our patient's bladder filled up and pushed her cervix and uterus to the right - which made it difficult for me to examine, grrr. At least our patient told us every time we felt her uterus/ovaries (she was very in tune with her body). She'd say with an odd smile, "Now you felt it!" And we'd all be like, "What? Let me try that again. I feel something, I just don't know what it is."

Anyway, that's that. TMI perhaps, but I just had to share. It's not every day that you can say that you've had your fingers down a woman's vagina and felt her uterus and ovaries (which I still can't distinguish from other things in that region internally). And truly, it was a good learning experience because the patient and physician were both awesome.

Questions? Yes, it smelled a bit but not too bad, hard to describe though. Also, different sex positions suddenly make a lot of sense, lol (light bulb moment for sure).


Michael said...

That sounds pretty cool in the medical sort of way! It reminds me of this video:

Ron said...

yeah i did my first pelvic and bimanual last year in 2nd semester.. the volunteers were incredibly chill about it and that made a big difference.

bimanual was yes, kinda tricky. and i was nervous that the blades of the speculum would like (as you close it when pulling it out) 'clip' onto a bit of the vaginal wall surface, and i can see how that can be uncomfortable. fortunately that didn't happen.

what weirded me out the most was feeling a pulse (yes, i felt a pulse!) while doing the bimanual, and also part of our exam was to get the volunteer to 'squeeze' on our 2 fingers to test that the motor component for the lumbar/pelvic spine or something. i don't know my anatomy well, in fact i suck at anatomy.

Mike said...

Details... hmmmmmm hehehe

Biki said...

I found this post to be rather funny, having been on the other side of way to many of those exams.

Aek said...

Michael: I'd HATE to be a male ob/gyn resident. Ugh.

Ron: I didn't feel a pulse. But I DID feel her vagina "squeeze" on my fingers a bit. I was like, "Woah, you can do that?" I shouldn't have been surprised, but I was.

Mike: Hehe, of course. :-P

Biki: I'm glad you're amused. So, can you tell where your ovaries are?

Biki said...

I dont know, where ever they throw the stuff they rip out of people.

naturgesetz said...

It seems medicine is not a profession for the squeamish.

Of course there is bound to be some "getting over it" and getting used to it, and eventually you get to choose a specialty you're comfortable with, but still you do have to be able to get past that initial discomfort.

So congrats on this step.

Uncutplus said...

Are the ovaries sensitive to palpation like the testes are?

Now your readers, Aek, are more interested in your description of the male apparatus including the manual prostate exam? When is that on your curriculum? (And we do want every little detail!)

fan of casey said...

Exam a guy next, that's what we all want to know. :-)

Aek said...

naturgesetz: Indeed, no squeamishness allowed in medicine!

Uncutplus: I don't know, but I don't think so.

Uncutplus, fan of casey: The male exam isn't for another couple weeks. Though, we just had that lecture today. The urologist was actually a great lecturer.