[Gynecologic examination, a role-playing for two].

Abstract

Although pelvic examination (PE) is a common procedure in gynaecological practice, there is little discussion among gynaecologists about the decision-making process and the possible indications and contraindications. Moreover, examiners need to be aware that their approach and body language during PE will inevitably reflect their attitude toward women. At PE, there is tacit agreement between the examiner and the patient involving a cognitive restructuring of the situation. However, if memories of earlier experiences bearing some resemblance to the PE situation are aroused in the patient, and the emotions connected with them reactivated, she may become overwhelmed by the intensive reactions triggered. In such cases, the examiner needs to be able to recognise what is happening and provide the support the patient needs. Other responsibilities of the examiner at PE include recognising symptoms of post-traumatic stress reactions and vaginismus. In performing a young woman's first PE, the examiner's primary aim should be provide the experience; that PE is a benign procedure, unconnected with pain or distress; as the patient's experience at her first PE will inevitably influence all future examinations. Learning to perform a PE in such a way that it is beneficial to the patient in all these respects is an intricate and challenging task. However, experience with students and gynaecological teaching associates suggests that such skills can be taught and learned. The PE situation is charged with latent salubrious potential, which is usually insufficiently exploited.