Once upon a time about 15 years ago I got my first pelvic exam. It was a horrifying day, not because I had a horrible doctor (Dr. Blair is awesome) but because there was a huge metal-looking duck bill expanding inside of my vagina. The image has stayed with me over the years. Now, I, Nurse Nikki, the FNP student am performing about 15 pelvic exams a day with those same metal duck bills. During my first attempt I'm pretty sure I hesitated about 3 times before I actually inserted the speculum. My ultimate goal is to minimize discomfort and any traumatic experiences to what is already, for first-timers at least, a mentally exhausting but necessary event.
Everyday I strive to improve my technique and decrease discomfort. I think the key to a successful pelvic exam is all in the patient's position. (My preceptor at Planned Parenthood is an awesome teacher) Instead of positioning the stirrups in an awkward outward position, I place them slightly parallel and ask the patient to then point her knees outward. Her legs resemble a frog's legs (for you visual folks). With her bottom on the very edge of the table and knees outward, this creates optimal viewing. I refrain from a whole lot of touching just because it's not totally necessary. A simple and light touch to the inner thigh alerts the patient I am about to begin. A comforting reminder to relax also helps. Sometimes a little pressure to the introitus is necessary to initiate relaxation.
Needless to say, I am by no means striving to become a women's health nurse practitioner. I commend them for their ability to simply focus on the female genitals for entire work days. I love primary care and its always in the back of mind. I always manage to add a few questions about cholesterol, glucose and weight management into each visit.
So I have about 10 more days left of performing about 10+ pelvic exams a day. I'm pretty sure that makes me the Queen of Pelvic of Exams (in the student category of course).