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Discussion

whiff test

I had a patient today who came in for BV. After the exam, she told me that 15 years ago, she went to see someone for the same issue, and mid-exam, speculum wide open and patient flat on her back, the provider said "Whew! You definitely pass the whiff test!"

She was, of course, mortified. And it took her almost 10 years to work up the courage to see an OBGYN clinician again :(

Sad. Just thought i'd share.

And as an aside, what is up with the whole flat on the back lithotomy thing for pelvic exams? I keep it low-ish for IUD insertions, but otherwise I keep the exam table at a relatively high fowlers unless there's a reason not to. What do you guys do?

I've also recently been reminded that many clinicians do not watch out for dragging labia when inserting a speculum. I've had that happen to me more than once and it HURTS! Being careful, keeping an eye on the patient's cues re: discomfort/pain, and making sure women understand why and how I am about to examine them- these things make a huge difference. Preaching to the choir, obviously :)

Final question- do you make your wet mounts in the room or do you bring your swabs to the scope to make slides? And why?

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    How sad about that provider's comment! How embarrassing for the patient.

    Regarding your last question - our providers bring the swabs to our lab to make the slides. They do put the saline into the tube with the swabs while in the room, generally. But it's easier to keep the slides in one place (where the microscope is) than have slides in every exam room.

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    That is very sad about the doctor's whiff comment. There are so many insensitive providers out there.

    For speculum exams I keep the table in more of a semi-Fowler's, I'm pretty tall and our tables and stool are kind of low so it's the position I've worked out to be the best possible for my visualization. I'm very, very careful when inserting speculums, I usually use my left hand to keep the labia spread while the right is pushing the spec in, and I go slowly.

    I collect my swabs in the room and then make up my wet mount slides in our lab, where the microscope, slides, saline, and KOH are all kept.

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    I remember when I worked in L&D and I worked with a midwife who was new to the practice. The mom had been pushing for a couple hours, everyone was pretty tired. The midwife was just sort of hanging back, watching. The mom passed some stool with pushing, and the midwife said "Can someone clean up that turd?" right out loud to the room. I was appalled.

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    I remember when I worked in L&D and I worked with a midwife who was new to the practice. The mom had been pushing for a couple hours, everyone was pretty tired. The midwife was just sort of hanging back, watching. The mom passed some stool with pushing, and the midwife said "Can someone clean up that turd?" right out loud to the room. I was appalled.

    How horrible! Glad I don't work with any a**holes like that.

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    I am starting clinicals soon... thanks for sharing this and horrifying me... we all need reminders. I have heard horror stories like this and thankfully have never experienced anything like that. Poor thing. I'll be following this thread to get good pointers from you all with experience!

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    Any advice for a 36 yr male starting his women's health FNP clinicals?

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