Mayo Clinic Rochester - Community Internal Medicine.
Assistant professor in medicine, Mayo Clinic in Rochester, Rochester, MN, USA.
J Prim Care Community Health. 2021 Jan-Dec;12:2150132721992195. doi: 10.1177/2150132721992195.
We reviewed the literature pertaining to anxiety and fear surrounding the pelvic examination to help guide health care providers' on available screening options and to review options for individualized patient management.
Anxiety and fear are common before and during the pelvic examination. In fact, the pelvic exam is one of the most common anxiety-provoking medical procedures. This exam can provoke negative physical and emotional symptoms such as pain, discomfort, anxiety, fear, embarrassment, and irritability. These negative symptoms can interfere with preventative health screening compliance resulting in delayed or avoided care and significant health consequences.
Assessing women for anxiety related to pelvic examinations may help decrease a delay or avoidance of examinations. Risk factor and symptom identification is also a key component in this. General anxiety questionnaires can help identify women with anxiety related to pelvic examinations. Strategies to reduce anxiety, fear and pain during a pelvic examination should routinely be implemented, particularly in women with high-risk factors or those identified with screening techniques as having anxiety, fear or pain with examinations. Treatment options should be targeted at understanding the patient's concerns, starting conversations about pelvic examinations early, educating patient's about the examination and offering the presence of a chaperone or support person. During an examination providers should ensure the patient is comfortable, negative phrases are avoided, the correct speculum size is utilized and proper lubrication, draping, dressing and positioning are performed. Treating underlying gynecologic or mental health conditions, consideration of cognitive behavioral therapy and complementary techniques such as lavender aromatherapy and music therapy should also be considered when appropriate.
我们回顾了与盆腔检查相关的焦虑和恐惧的文献，以帮助指导医疗保健提供者了解可用的筛查选项，并回顾针对个体化患者管理的选择。
在盆腔检查之前和期间，焦虑和恐惧很常见。事实上，盆腔检查是最常引起焦虑的医疗程序之一。该检查会引起负面的身体和情绪症状，如疼痛、不适、焦虑、恐惧、尴尬和易怒。这些负面症状会干扰预防性健康筛查的依从性，导致检查的延迟或回避，以及严重的健康后果。
评估女性对盆腔检查的焦虑可能有助于减少检查的延迟或回避。识别风险因素和症状也是关键组成部分。一般焦虑问卷可以帮助识别与盆腔检查相关的焦虑的女性。应常规实施减轻盆腔检查期间焦虑、恐惧和疼痛的策略，特别是在具有高风险因素的女性或那些通过筛查技术确定有焦虑、恐惧或疼痛的女性中。治疗选择应针对了解患者的担忧、尽早开始关于盆腔检查的对话、教育患者有关检查以及提供陪伴者或支持人员。在检查过程中，提供者应确保患者感到舒适，避免使用负面措辞，使用正确的窥器尺寸，并进行适当的润滑、覆盖、穿衣和定位。治疗潜在的妇科或心理健康状况，考虑认知行为疗法和补充技术，如薰衣草芳香疗法和音乐疗法，也应在适当的情况下考虑。
