Practitioner's tip: Here is a little tip to use that may help to evaluate a woman's tolerance for the speculum insertion and the vaginal examination. It also may serve to alleviate anticipation and fear of discomfort, or pain for the very young women, adolescents, and sexually inexperienced women, and aids in the practitioner’s job as well!
The examiner can place an index finger approximately one inch into the vaginal opening over the posterior fourchette. The inserted finger can cover and protect an injury that may be present to the posterior fourchette prior to insertion of the speculum. The index finger can also be used to apply gentle pressure to the pubococcygeus muscle (p-c muscle) at lower portion of the vaginal opening. While doing this, the examiner can explain to the woman that this is the area to relax to make the pelvic examination less uncomfortable. Women may tolerate the insertion of one finger and the slight pressure on the muscle, which tends to initiate relaxation of the muscle. Informed women may feel less sensitive and anxious regarding the insert ion of the speculum if the examiner uses this technique. The speculum can be slipped into the vagina over the inserted finger, as the finger is removed. Many gynecology experts to help women relax during a procedure that may be considered anxiety provoking and uncomfortable have used this technique. Tips that make the patient comfortable allow for a more relaxed practitioner as well and information gained from an examination is maximized.
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