What is not recommended during a routine pelvic examination and Pap smear?

Kneeling at the Knees to Avoid Eye Contact is NOT Recommended

The practice of kneeling at the knees to avoid eye contact during pelvic examination is not recommended and contradicts best practices for patient-centered care. This approach undermines communication, patient comfort, and the therapeutic relationship that should be maintained throughout the examination.

Why This Practice is Inappropriate

Compromises Communication and Patient Autonomy

• Avoiding eye contact prevents the clinician from monitoring the patient's facial expressions for signs of discomfort, pain, or distress during the examination 1
• This practice interferes with the ability to explain each step of the examination in advance, which is a recommended practice to reduce anxiety 1
• Approximately 30-35% of women experience fear, anxiety, embarrassment, pain, or discomfort during pelvic examinations, making visual communication essential 2, 3

Contradicts Evidence-Based Examination Techniques

• Proper pelvic examination technique requires the examiner to maintain professional positioning that allows for adequate visualization while preserving patient dignity 1
• The examination should include assessment of external genitalia, speculum examination, and bimanual palpation when clinically indicated, all requiring appropriate positioning 1

Recommended Practices During Pelvic Examination

Communication and Preparation

• Explain each step of the examination in advance to reduce patient anxiety and ensure informed consent 1
• Use anatomic models, pictures, and educational materials, particularly for adolescents or first-time examinations 1
• Discuss the presence of a chaperone openly with the patient before conducting the examination 4

Chaperone Utilization

• Over 90% of patients consider the presence of a chaperone appropriate during intimate physical examination 4
• 84% of patients feel that doctors, regardless of gender, should always request a chaperone 4
• Chaperones provide psychological support, protection against sexual harassment allegations, and an objective account should legal issues arise 4

Technical Considerations

• Warm the speculum with tap water before insertion to minimize discomfort 1
• Avoid unexpected or sudden movements during the examination to reduce patient anxiety and physical discomfort 1
• Use water-based lubricant on gloved hands for bimanual examination 3

Special Populations Requiring Extra Sensitivity

Women with History of Sexual Violence

• Women with history of sexual violence, particularly those with PTSD, experience significantly more pain, discomfort, fear, anxiety, or embarrassment during pelvic examinations 2
• These patients require additional preparation, communication, and sensitivity during the examination 2

Adolescents

• First pelvic examination should only be performed when clinically indicated 1
• Adequate preparation is essential, including use of educational materials to reduce anxiety 1

Common Pitfalls to Avoid

• Performing routine screening pelvic examinations in asymptomatic, nonpregnant adult women, as this practice is not supported by evidence and may cause unnecessary harm 2
• Failing to maintain professional eye contact and communication throughout the procedure 1
• Not offering or discussing the option of a chaperone before beginning the examination 4