Female genital examination and testing is essential to correct diagnosis and management of sexually transmitted infections in women. Developing a rapport with the client and maintaining her confidence throughout the examination is paramount, as some women may be fearful of the process, anticipating physical and psychological discomfort such as pain and embarrassment. Earlier negative experiences can exacerbate these fears. Although a means to effective examination, the speculum is not without emotive connotations for some women.

Establishing the woman's previous experience of examination, recognising and exploring any concerns and responding to verbal and non-verbal cues should be done prior to the woman's undressing for examination.

Verbal consent to examination should be obtained. The process and purpose of the examination should be fully explored to ensure that the consent that is given is truly informed. The patient should be advised to report any pain or discomfort experienced during the examination and that she can call a stop to the examination (i.e. consent can be withdrawn) at any time. In those under sixteen years, the Fraser guidelines (House of Lords, 1985) should be strictly adhered to in order to assess competence to consent to the examination. In Scotland, guidance is given in the form of The Age of Legal Capacity (Scotland) Act 1991. For further information see Chapter 7: Legal Issues in Sexual Health.

The use of a chaperone remains a grey area. A chaperone is one who observes the examination and can advocate on behalf of the client, supporting her during the procedure. As a witness to the examination, the chaperone may also advocate on behalf of the practitioner in the event of client complaint. Male practitioners have historically required a female chaperone during female examination. It is important that the chaperone is able to recognise, raise and justify concerns, possibly against a very senior colleague.

Advanced Clinical Skills for GU Nurses. Edited by Matthew Grundy-Bowers and Jonathan Davies © 2007 John Wiley & Sons Ltd

An ineffective chaperone may be worse than no chaperone, as the client herself may be less likely to raise concerns or call a halt to the examination if the second person says nothing. In some cases an additional person in the examination room may exacerbate the woman's more general anxieties - for example, concerns about body image. Within current guidelines it is considered good practice to offer the client a chaperone; and it is essential in some circumstances. Clear documentation should be kept, including the name of the chaperone. Specific guidelines for nurses have been published by the Royal College of Nursing (RCN 2002).

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