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).