If you’ve made through the didactic year and started rotations, chances are this may be a dreaded clinical. Prior to starting clinicals, my program hired people to allow us to practice the GU exam. I have no idea what low spot these people were in to allow 42 pelvic exams in a row, but maybe they were just dedicated to higher education. Luckily, I had some idea of what I was doing on my Gyn rotation….spending a lot of time in “the crease” before I set foot in the door. My most memorable patient was an elderly demented woman brought in from a nursing home. The chief complaint was “She put something in down there”. I was sent into the room with a non-verbal patient to do a pelvic exam. One of the CNA from the home was there to “help”. The speculum was lubed and inserted and….Whaaaaaat? There was not just one thing, there were THINGS. Plural people. I removed bottle caps, tea bags, and an eraser. What kind of nursing home was this? The emitted smell sent me to another world and I felt horrible for this frail old woman. I discarded the objects into the garbage and finished up the exam. After completing this almost impossible task, I got chewed out for not double gloving the previously inserted objects prior to throwing them away. I banked that one for future use! The following are a few heads up that no one ever told me.
1) Many gynecologists are not practicing obstetricians. If you want any experience with pregnancy or deliveries, make sure you find the right clinic.
2) Get your game face on, you will be seeing and hearing about some of the most intimate issues women face. Do not show any signs of surprise or you just lost your patient. As far as they know, you have always known that people get irritation around their recent clitoris piercing.
3) Prior to starting rotation, go over birth control methods. A large portion of the rotation will be about starting/adjusting/discontinuing contraceptives.
4) Dysfunctional Uterine Bleeding….own it.
5) If there are any procedures done at the clinic, get involved! Colposcopies, IUD insertion, Bartholin’s abscess I&D, marsupialization, among others are all really cool things to see, and will cross over to primary care and the ED
6) There will be pro-life/pro-choice discussions…its uncomfortable.
7) Women come to the clinic with very scary situations and diagnosis. Cancer diagnosis and abuse are two examples that pop into my mind. Guide and care for these women carefully.
8) Don’t judge. Its not our place. Gentle discussions about lifestyles are within our scope. Making them feel horrible about themselves because they are in being treated with a second STI from the same partner is not our place.
9) Please…..please, from the bottom of my heart, use lube on that speculum, every time.
10) This may be the job for you if you enjoy seeing many patients a day with similar complaints, but you get to know them at deeper level. There is some variation and higher complexity, but you have to be dedicated to pelvic exams. Many PAs enjoy a high level of autonomy in this field!
FOOTNOTE- I was corrected by a veteran PA who is in the Gyn field. She states that too much lube can actually ruin the wet prep or cytology results. Use in moderation