Maintaining A Safe Environment

Although female genital examination is not a sterile procedure, advance preparation of the clinical environment is necessary to maintain infection control during the examination. The examination couch is cleaned with detergent-based wipes and covered with examination paper. The examination trolley is cleaned with alcohol-based wipes and the examination light is cleaned also. Equipment is arranged so as to prevent possible cross-contamination during the procedure: for example, the light is positioned prior to the examination. Careful hand washing is necessary both before and immediately after the examination. Protective gloves should be worn during the procedure and when handling waste. Care should be taken to dispose of sharps and clinical or domestic waste appropriately.

Care should be taken to ensure correct labelling of all samples. Within GUM, samples are usually labelled with an individual clinic number and date of birth only. Details should be checked against the notes and confirmed with the patient.

It is important to confirm that the patient understands exactly which samples will (and will not) be taken. For example, clarification that a cervical smear is not part of the examination may influence her decision to attend for future cervical screening. On the basis of clinical findings, the need for additional samples may arise. The patient should be informed and give consent to all tests undertaken.

Privacy and dignity should be maintained at all times. The door should remain closed and curtains/screens should be used. The practitioner should leave the room to enable the woman to undress (from the waist down) in private. A cover should be offered and the patient invited to sit on the couch when changed. Before re-entering the room, the practitioner should knock and state his/her name.

It is important to ensure that the patient is correctly positioned on the couch and as comfortable as possible before starting the examination. The patient should be asked to sit at the front edge of the couch and then to lie back with the backs of the knees supported by the leg rests. Her arms should ideally rest at the side of her body, as stretching back tightens the abdominal muscles (Jarvis, 2000). Monitoring the patient during the examination (for example for gripping the couch or breath-holding) can enable feedback to be given to help reduce muscular tension, facilitating ease of examination for both patient and practitioner.

The practitioner should be aware of the potential risk of a vasovagal episode on taking cervical swabs. Assessment should be made to identify those prone to fainting, particularly women who have experienced a vasovagal episode during a previous examination. A colleague should be informed prior to the examination and emergency equipment (including oxygen) should be readily available. The patient should be observed for signs of pallor, yawning, dizziness, nausea or fainting during and immediately after the examination. After the examination, the practitioner should encourage the patient to remain supine and not to sit up too quickly.

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