Mirror, Mirror on the Wall: The Pelvic Exam

I didn't feel outwardly nervous about the pelvic exam. My heart wasn't racing and my stomach wasn't turning. Yet, my actions would have suggested otherwise. I walked into the room and signed in as being present for the session. I then looked down and noticed I had signed in as another classmate. While I quickly crossed out my name and re-wrote it, I then sat down and immediately broke the plastic speculum we were given for learning purposes. Yes, I straight up disconnected it from itself and had to look at my friend and hope she could fix it while I just sat there thinking: "OH. GOD. This is embarrassing. I must be nervous after all."

The woman in charge then walked in and gave us a synopsis of what we were going to do. It was literally the longest laundry list of things ever and I think I zoned out somewhere between the introduction we needed to tell our patient and step 1 of the exam. Luckily, before we did it ourselves, we also had it "modeled" for us by a teacher.

When it came time for our turn to actually try it ourselves, our instructor asked if anyone was "dying" to go first. Being split up from the only other girl present (yes, they really did that), the two guys with me sort of looked away and did the "do do do...you don't see me face". Knowing it was a battle I would not win, I ended up stepping up and agreeing that "sure, I was ready...and sure, I would go first".

I started with my schbeal to the patient (pretty much the only thing I retained from the steps I had now heard and seen). I asked if she had ever had a pelvic exam before, how that experience was for her, and then explained how MY exam was going to be comfortable (Lies. I mean...sure, the first exam I will ever give will be SUPER comfortable). We also had to explain step by step what we were going to do, without using dirty or inappropriate sounding words (when all else fails...use the word..."examine"). I then asked the instructor, "What if your patient doesn't know what a speculum is...how do you explain that...in nice words" (as literally, all I could think of to say was that it is this metal contraption that sort of looks like a duck that gets put somewhere you probably don't want to imagine it going). Her response was direct and honest: just show the patient.

I then had to set up the room. This included moving a light, getting the patient in the "footies" (yes, that is what our person said to call them instead of using horseback riding references), making sure a trash can was within an arms reach, and providing the patient with a mirror "in case she wanted to follow along". Even though I have never been asked by a doctor to "watch along", nor would I EVER want to see what I have going on down there, apparently it is proper protocol to let the patient have a mirror and decide for herself. When I pointed out that I had never been offered one, my instructor explained, well now I know, and now I will make sure I get one. To which I thought (but didn't respond)...HA! YEH RIGHT (or to quote Cher Horowitz "As if").

Finally, it was time for the exam to start. For the purposes of not getting completely into moderately voyeuristic detail here, I will tell you a few observations and things I learned from this experience:


1. The first thing you do in an exam is "look for movement". To quote my instructor, if you see it..."run and have them reschedule".  This was gross, but also pretty hysterical, at least when you finally get past the gross-ness.


2. I might be ambidextrous. There is this way to use your 2 fingers as a "tool" (that word was repeated to me over and over) and I can not tell you the number of times I was told that I was using the wrong hand or the wrong finger for something. I kept thinking I was doing it right, but I learned that there must be somewhere in my mind where the wires are crossed and my motor output was just doing it the easy way (with whatever hand felt comfortable). For the correct exam, you have to use your hands in a way as to not offend a patient or sort of dominate them in an uncomfortable almost sexual way (which I get), but for some reason it was impossible for me to get my hands to do what the instructor was yelling at me to have them do. At one point I wanted to slap the incorrect hand and say "bad hand", but that would have been going overboard.

3. Having small hands mattered MUCH more for the pelvic exam...than it did for the prostate one. I know I said before that people had warned me about my tiny hands being an issue for ultimately finding the prostate, but not ONE person had done this for the pelvic. In order to find the cervix (needed for actually scraping cells and looking for abnormalities), I literally had to stand up, put my foot on a stool and brace myself (Yes, that image you are imagining is probably right). It was...uncomfortable to say the least. Awkward, to say the most. And, ultimately it was a bit hilarious when the guy after me went...thinking he would need to do that too, and with his big hands he actually overshot...where he was supposed to be. WOOPSIE.

4. Feeling for the uterus and ovary is...old school medicine. Because I was the first to go, and the instructor did not explain the bimanual exam to begin with, I had to be the one who did the exam while the patient acted as the instructor and the other two students attentively watched my every move. In this exam, you are feeling for the uterus and ovaries with your fingers, while sort of pushing on the abdomen. It requires a vast knowledge of anatomy, weird swipes of your hand on the outside of the person's abdomen (including some that feel like you MUST be hurting the patient), and a little bit of "sure" that random little lump I felt MUST be the ovary...and SURE it felt normal (at least for me in this case... hopefully NOT for doctors who actually need to be doing this and finding malignancy). I definitely felt the ovary, which was oddly like a little quick swipe of a golf ball on your finger, but I definitely did NOT feel the uterus...even though it's bigger... I spent about 10 minutes trying to find it...and totally said I "thought I felt it". Oh well.

When I entered medical school, we were asked to write down which specialty we would absolutely never do (potentially because we would end up actually choosing that despite our preconceived notions), and I wrote down OB/GYN. I was definitely right. If my one pelvic exam experience taught me anything it is that I cannot spend my life doing that...and am pretty nervous having to do it on medicine and OB/GYN rotations in medical school. It just...for lack of a better phrase...wasn't my favorite.