A Patient’s Guide to Sensitive Medical Exams and Procedures
At University Health Services, one way we provide the best possible care is to adopt or establish standards for the protection of patients and providers. Our Chaperone Policy establishes a standard of care for sensitive exams and procedures. A chaperone is a witness who may assist patients and health care professionals in completing sensitive exams and procedures in a consistent, safe and respectful manner. A chaperone will always be present during sensitive exams. Patients or providers may request a chaperone at any time during a visit for medical care at University Health Services.
What is a “sensitive” exam or procedure?
A sensitive examination or procedure includes the physical examination or a procedure involving the genitalia, rectum, or female breast. A chaperone will be provided for all sensitive exams or procedures.
Depending on the sensitive exam or procedure, patients may feel some discomfort or pressure, as well as mild to moderate pain with specific procedures. Patients experiencing moderate to severe pain, tenderness, or excessive pressure should alert the provider immediately.
Patients may find certain exams or procedures distressing due to mental health needs, neurodevelopmental issues, cultural or religious reasons, or other personal concerns. For these reasons, chaperones may be requested by the medical provider or patient for non-sensitive exams or procedures.
Patients should feel free to ask questions at any point during an exam or procedure.
Sensitive Exams described in more detail:
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A breast exam is performed when there is a breast concern such as pain or lump.
Providers may offer screening breast exams to patients as part of the annual exam or based on personal and family risk assessment.
Breast exams may include:
Visual Exam: Patients raise their arms above their heads to allow providers to check for differences in size or shape between breasts as well as signs of a rash, dimpling, lumps or other breast skin changes. Visual breast changes may be conducted in a seated position or while lying on an exam table.
Manual Exam: The provider uses the pads of the finger to palpate the entire breast, underarm, and collarbone area for lumps or abnormalities. Providers will also check to see if lymph nodes under the armpit are enlarged. Nipples may be lightly squeezed to check for expressed fluid.
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Patients typically have a pelvic exam upon experiencing symptoms such as discharge or pain, or at the age of 21.
Pelvic exams may include:
External Exam: Visual inspection and palpation of external labia, clitoris, vaginal opening, perineum, and rectal area. These exams are typically conducted with the patient lying down on an exam table with a drape covering the lower abdomen and pelvic area with the feet in foot holders.
Speculum Exam: A duck bill-shaped instrument is gently inserted into the vagina and opened to provide visual access to the vaginal canal and cervix. The provider may also conduct a Pap test for patients age 21+ by using a thin plastic brush to collect cells from the cervix. Additional sampling may be collected for STI testing and for evaluation of vaginal discharge.
Bimanual Exam: A provider will insert 1-2 gloved fingers into the vagina while using the other hand to gently apply pressure and palpate the lower part of the abdomen. The purpose of the bimanual exam is to check the size and position of the ovaries, uterus, and cervix, and to evaluate for pain or tenderness of these areas as well as the pelvic floor and bladder.
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Urogenital exams may be performed if a patient is experiencing pain, swelling, discharge, has sores, or other symptoms. Some patients may develop erections, a normal response to anxiety, temperature change, and touch, during the examination.
Urogenital exams may include:
Pubic Area and Groin Exam: A visual examination and palpation of the scrotum, groin, hip crease, inner upper thigh crease, and lower abdomen to check for abnormalities, especially along the lymph nodes of the hip area, testicles, and the spermatic cord connected to the testis inside the scrotum.
Penile Exam: A visual and manual examination of the penis, including the skin, foreskin, glans, and urethra to check for pain, sores or other medical issues. Providers may ask uncircumcised patients to retract the foreskin back in order to examine all surfaces of the penis for sores and lesions and may palpate the area for irregularities. The provider may also examine the opening of the urethra and use a swab to collect a lab sample.
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Providers may perform rectal exams on patients experiencing pain in the lower abdomen and reproductive organs, bloody stools, or other gastrointestinal or rectal symptoms. Rectal exams are also performed to collect tests for sexually transmitted infections of the rectum.
Rectal exams may include:
External Exam: Providers visually examine the anus and surrounding area to look for sores, rashes and bumps, sometimes aided by a light to see better. The provider may collect tests for sexually transmitted infections by placing a cotton swab approximately 1 inch (2-3 cm) into the rectum, gently rotating, and removing the swab.
Digital Exam: The provider inserts one gloved, lubricated finger into the anus, palpating to detect lumps or abnormalities. In male patients, the provider may palpate the prostate gland to check for pain or tenderness. This exam may include fecal collection for hemoccult testing.
Anoscope Exam: The provider uses an anoscope to examine the anus and rectum. The lubricated anoscope is gently inserted into the rectum and slowly withdrawn as the provider exams the rectal canal. To ease the placement of the anoscope, the provider may ask the patient to intensify and relax internal muscles (as if having a bowel movement) during insertion. The provider may position a light or ask a chaperone to hold a light during the procedure.
