From the Guidelines
Creating a comfortable environment and establishing rapport with both the adolescent female patient and her mother is crucial before initiating the physical examination, as recommended by the American Academy of Pediatrics 1. This approach is essential to ease any anxiety about the visit, particularly regarding fears related to the examination. Key aspects of this approach include:
- Explaining what will happen during the exam to reduce fear and uncertainty
- Beginning with a light, friendly conversation to help the patient feel more at ease
- Providing privacy by asking the mother to leave the room for a portion of the examination, particularly when discussing delicate subjects like mental health and sexual health This enables a more candid and open discussion, allowing for the disclosure of sensitive information and building trust between the provider and patient. As noted in the American Academy of Pediatrics clinical report 1, the gynecologic examination can be a positive experience when conducted without pressure and approached as a normal part of routine young women’s health care. By prioritizing the patient's comfort and privacy, healthcare providers can improve healthcare outcomes by encouraging open discussion of sensitive topics that might otherwise remain undisclosed. The American Academy of Pediatrics promotes the inclusion of the pelvic examination in the primary care setting within the medical home, and recommends that examination of the external genitalia should be included as part of the annual comprehensive physical examination of children and adolescents of all ages 1.
From the Research
Approach to the Physical Exam
The approach to the physical exam for an adolescent female patient is crucial in creating a comfortable environment and establishing rapport.
- Creating a comfortable environment for the adolescent female patient is essential prior to initiating the physical examination 2.
- Establishing rapport with both the patient and her mother is crucial to ease any anxiety about the visit 3.
- Explaining what will happen during the exam and beginning with a light, friendly conversation can help the patient feel more at ease 4.
- Asking the mother to leave the room for a portion of the examination can help protect the patient's privacy, particularly when discussing delicate subjects like mental health and sexual health 5.
Importance of a Trusting Environment
A trusting environment can mitigate worries and improve the patient-provider relationship.
- Early discussions and performing the examination in a trusting environment can reduce stress and anxiety for adolescents 6.
- A non-threatening environment can minimize "exceptionalization" of the female genitalia and strengthen the patient-provider relationship 6.
- The health care provider must develop rapport to foster high-risk health behavior disclosure and promote health messages 3.
Patient-Provider Relationship
The patient-provider relationship is critical in adolescent healthcare.
- The provider of adolescent health care is uniquely qualified to provide factual health information and practical advice 3.
- Enlisting parental support for confidential adolescent health services usually is not problematic when parents and health care providers share common goals and responsibility 3.
- The physician's concerns regarding the health of adolescent patients will be welcomed by patients, their parents, and the community 3.