Sunday, July 18, 2010

The Art and Joy of Pelvic Exams

Posted by Katy

"Scoot Down. Relax your vagina. Why? So you can shove mean cold duck lips inside of it? I don't think so" -Vagina Monologues

This spring, two of the beautiful student midwives organized a bilingual rendition of the Vagina Monologues at the medical center here, involving nursing, medical, and physical therapy students, a professor, and women who work in the violence support center of Alianza Dominicana, a local community health organization. I performed the Angry Vagina monologue which railed on poorly performed pelvic exams. Now, I'm learning how to give pelvic exams, hopefully in a more empowering, de-mystifying, sensitive way!

This week, I performed my very first pelvic exam-- on myself. Despite having distributed speculum and having encouraged woman to examine their own cervixes and vaginas in college, I didn't actually do one successfully on myself. Seeing my own cervix and vagina in such detail and with the depth of knowledge I've gained recently was enlightening and empowering. On Friday, I gave my second and third pelvic exams to two very generous fellow midwifery students under the guidance of a calm and well-informed professor who made the environment relaxing and educational.

Some important pelvic exam vocabulary:
-the end of a speculum is a bill not a blade
-the things you put your feet in are foot ends not stirrups
-you place your fingers not insert them

A word on peer-pelvic exams: in our program, we learn to do pelvic exams by learning on each other. This is a fairly controversial practice. The major points against this method are that it is not necessary to have gotten a pelvic exam in order to become a midwife, much like we don't have to have given birth in order to wonderful midwives and a heart surgeon surely does not have to receive heart surgery in order to be the best surgeon. Additionally, there is concern that if midwifery students are forced or coerced to get pelvic exams from students, it may cause or exacerbate trauma and be a dis-empowering experience. I understand these critiques and feel that it is of vital importance that midwifery students are not coerced into doing peer-pelvic exams. However, in my own experience, giving and receiving pelvic exams with peers emphasized the importance of learning to give a pelvic exam that is so gentle and respectful of the woman that you would give feel comfortable giving it to your sister, mother, friend, or even yourself. I felt very comfortable and honored to have the opportunity to contribute to the learning of this art by my fellow students.

The pelvic exam and pelvimetry is among the first skills that we are learning that is more or less unique to midwifery. It comes with an enormous responsibility and trust that fills me with excitement about this journey. The emphasis on respectful, empowering care imparted by the faculty is validating of this route towards midwifery!


  1. I agree Katy! It's very important. My preceptor does the fastest and gentlest pelvic exams ever. I'm glad to have learned from her.

  2. How much interest would there be providing a pelvic examination with no stirrups, no speculum, no external lighting, no more discomfort than inserting a tampon, no peering between the legs, no need to get disrobed, etc? Could view entire vaginal canal/tissue from vulva to cervix without being obscured by a speculum?

    Enhanced magnified detail could identify infections, lesions, pre-cancer, bleeding, cuts, etc. conditions long before a traditional visual inspections, and often times before abnormal cells are available in enough quantity for reliable Pap screening? The entire procedure could be recorded for later review by a trained specialist – or have a specialist on-line while the procedure is being performed – remotely from home, farm, rural area, undeveloped country, etc.

    What about ability to determine potential for pre-term complications early in the pregnancy, frequent monitoring of cervix at home by the mother herself, monitoring dilation of cervix during labor, and viewing delivery itself, real-time on a monitor, smart-phone, iPad, etc? The entire procedure could be recorded for later review by a trained specialist – or have the specialist on-line while the procedure is being performed – remotely from home, farm, rural area, undeveloped country, etc., etc.

    This technology is coming soon. To ensure the most advanced, functional and beneficial product, your comments and suggestions are appreciated. Please respond to < >