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| Unsure of Your Gynecologic Exam Skills and Knowledge? |
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by R. Mimi Secor, MS, MEd, FNP-BC, FAANP - May 22, 2011
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Are You Unsure of Your Gynecologic Exam Skills and Knowledge?
Are you “Itching to Know” More about the Challenging Gyn Exam, Chronic Vaginitis,
and the New 2010 CDC STIs Treatment Guidelines?
Women’s Health expertise is required of many advanced practice clinicians, yet often our basic educational programs do not adequately prepare us to manage the complexity of patients and conditions we face every day in clinical practice. In addition, New 2010 CDC STI Treatment Guidelines and New 2010 CDC Medical Eligibility Criteria for Contraceptive Use were released by the CDC recently. There are also new cervical cancer screening guidelines (Pap and HPV testing) that were recently issued. In order for clinicians to be evidenced-based they need to incorporate these recommendations into their clinical practices.
Refining your Gynecologic exam skills must include knowing how to efficiently and accurately obtain a comprehensive but focused history, how to perform a step by step gynecologic exam including preparing for and conducting the exam, educating and supporting the patient throughout, carrying out in-office procedures such as testing for vaginal pH, and performing a vaginal wet mount (microscopy) and collecting/conducting additional tests as indicated by the history. Taking an accurate sexual history is challenging and requires the clinician know what questions to ask and how to conduct the interview often while navigating sensitive subject matter and challenging psychological issues. This process requires excellent communication, clinical skills and experience.
It can be challenging to examine special populations and specific strategies are often required to successfully complete the gynecologic exam particularly for patients who are overweight, pediatric, elder, disabled, anxious, symptomatic, or have been sexually abused or have vaginismus.
The New 2010 CDC STI treatment guidelines are updated and expanded. There are new sections focusing on the female patient that include; diagnosis, treatment and follow-up for cervicitis, female sexual assault, and new treatment regimens for STIs, vaginitis and PID. These new guidelines also include management recommendations for pregnant patients.
There are over 11 million visits each year in the US for patients with vaginitis yet often the clinical diagnosis is not obvious or accurately established. Empiric treatment may lead to continued symptoms, complications and both patient and clinician frustration. Honing your diagnositic and management skills is facilitated by continuing education programs that include updating in-office and laboratory diagnostic testing, interactive discussion, case studies, and use of video vaginal microscopy to enhance diagnostic acuity and accuracy. New in-office diagnostic testing includes the new VS-Sense vaginal pH swab test that is simple, quick and accurate, eliminating the need for the use of multi-step traditional vaginal pH tests. To learn more about this new test go to www.Cs-commonsense.com.
Differential diagnosis of Vulvovaginitis is often complex and challenging. Vulvitis may be associated with a host of causes including; over cleansing, irritants, allergens, dermatologic conditions including lichen simplex chronicus (LSC), lichen sclerosis (LS), lichen planus (LP), cancers and pre-cancers, STIs, and hormonal influences.
Vaginitis may be caused by STIs including genital herpes, (affecting 1 in 6 Americans) and Trichomoniasis (as high as 22/100 teens may be infected). It is estimated that only 40% of at risk women 25 years of age and younger are screened for chlamydia. In addition, 75% of women and 50% of men with chlamydia are asymptomatic which further contributes to the development of complications including chronic pelvic pain, infertility and PID (often subclinical and undetected).
Considered sexually associated but not sexually transmitted, bacterial vaginosis (BV) is the most common vaginal infection with a high rate of recurrence of up to 30% within one to three months after treatment. Approximately half of patients lack symptoms while others may report an abnormal, malodorous discharge. BV is associated with many significant health issues including an increased risk of STIs, cystitis, PID, preterm labor, and increased risk of post gynecologic surgery infections.
Early diagnosis, effective treatment, appropriate patient education and follow-up are essential for the successful management of gynecologic problems and various STIs and vaginitis.
Learn more about the Challenging Gyn Exam, the New CDC STI Guidelines, Chronic Vaginitis, Video Vaginal Microscopy, Clinical Conundrums, Practice Pearls and much more, at my day long presentation in Orlando, September 7th, 2011 at “The Skin, Bones, Hearts and Private Parts Conference”.
Mimi Secor is a Nurse Practitioner at Newton Wellesley ObGyn, in Newton, MA where her career-long specialty is managing patients with vulvovaginal problems. She has 33+ years of experience in women’s health, has been a clinically focused educator for decades, and is Coauthor with Helen Carcio of a new textbook, Advanced Health Assessment of Women; Skills and Procedures. Mimi is a nationally noted speaker and consultant, a Visiting Scholar at Boston College, and the co-host of “Partners in Practice,” a weekly radio broadcast on ReachMD. She received the 2010 “Shout Out” Award from Advance for NPs and Pas for her media work on ReachMD, Good Morning America, the Boston Globe, Wall Street Journal and many others. Mimi can be contacted via www.mimisecor.com.
The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.
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