Clinical Tool
Pelvic Exam Tool & Protocol
A step-by-step, trauma-informed approach to the pelvic exam. Start by building the patient's preference plan, then follow each phase, using the language guide and crisis protocol as references. The protocol is based on the practice guideline from Dr. Tuttle's DNP project. To use it offline at the bedside, add it to your phone.
Interactive Pre-Exam Patient Preference Builder
Set these options with the patient before step 1 so the exam room matches what they have chosen.
Sitting up allows eye contact throughout the exam.
Lets the patient see what you describe as you go.
All contact stops the moment it is used.
Where the second staff member stands during the exam.
Agreed exam plan
- Backrest raised to 45° for continuous eye contact
- Hand mirror offered during narration
- Stop signal: raised palm
- Chaperone at head/shoulder
Saved plans
Plans are saved only on this device. Label them by room or time, never by patient name.
No saved plans yet.
Scripting
Two Words That Give the Patient Control: “Stop” and “Out”
Explain both words before the exam begins. They only build trust if you follow through every time a patient uses them.
“Stop”
means: My hands and any instruments stay exactly where they are, and I stop moving until you tell me it’s okay to continue.
“Out”
means: I immediately and gently remove my hand and any instruments.
Ask the patient: “Do these words work for you?” If not, choose different words together.
Adapted from the scripts of The Feminist Midwife.
Protocol
5-Phase Interactive Examination Protocol
Phase 1 of 5
Before the Exam: Ask, Explain, Consent
Give the patient power before anything begins. Talk in a private room while the patient is dressed and you are seated at or below their eye level.
- Knock and ask permission before entering. Use a private room with a door that closes.
- Ask whether they would like a family member or friend present for any part of the exam.
- Explain why you would like a second staff member in the room. The patient may decline; document it.
- Ask whether they have had a pelvic exam before, how it went, and whether anything would help this time.
- Explain why the exam is needed, each step, and the equipment (speculum, swabs, lubricant), including any bimanual exam.
- Answer questions, then get verbal consent for every part. The patient may decline any part; document it.
- Teach the words "Stop" and "Out," and follow through immediately whenever they are used.
"Have you had a pelvic exam before? Is there anything about past exams that would be helpful for me to know?"
Communication
What to Say Instead
Small changes in wording change how safe the exam feels. Use this table to replace common phrases with trauma-informed alternatives.
Instead of
"Just relax."
Try saying
"Let your knees fall to the sides whenever you're ready."
Gives the patient a concrete action they control. Many patients cannot relax on command.
Instead of
"Spread your legs."
Try saying
"Let your knees fall apart until they are touching my hands."
Removes wording that can echo past assault. Your hands, held outside the knees, show how far; never push knees apart.
Instead of
"This won't hurt."
Try saying
"You may feel pressure. Tell me if anything is uncomfortable and I'll stop."
Honest expectations build trust. If you promise no pain and it hurts, the patient stops trusting you.
Instead of
"Good girl." / "Good job."
Try saying
"Thank you, that's really helpful."
Avoids infantilizing praise that is a common trigger for survivors.
Instead of
"I'm going to stick this in."
Try saying
"I'm going to place the speculum now. You'll feel me touch the entrance first."
Uses clinical, neutral words and tells the patient exactly what comes next.
Instead of
"Stirrups" / "blades"
Try saying
"Footrests" / "the sides of the speculum"
Swaps restraint and weapon imagery for neutral equipment terms.
Instead of
"Almost done, just a little longer."
Try saying
"About 20 more seconds. I'll count down for you."
A specific time limit is easier to tolerate than an open-ended one.
Instead of
"Why are you so tense?"
Try saying
"Would you like to pause or change position?"
Offers a choice and avoids suggesting the patient is doing something wrong.
Crisis Protocol
Stop-Signal & Dysregulation Algorithm
Follow these steps in order whenever the stop signal is used or the patient shows signs of a trauma response.
STEP 1 · STOP
Stop all contact immediately
The moment the stop signal is given, or distress shows (freezing, crying, shallow breathing, dissociation), stop moving. If a speculum is in place, say so, close it, and gently remove it.
"I've stopped. Nothing is happening right now."
STEP 2 · COVER
Restore coverage and space
Step back from the table, pull the drape up, and offer to raise the backrest so the patient can sit up. Lower your voice and slow your pace.
"You're covered. Would you like to sit up?"
STEP 3 · GROUND
Orient to the present
Offer simple grounding: name the place, date, and people in the room; suggest pressing feet into the floor or slow breaths out. Offer water. Do not touch the patient without asking.
"You're here at the clinic with me. You're safe. Can you feel your feet on the floor?"
STEP 4 · CHOOSE
Give control back
Once the patient is calm, offer real choices: continue with changes, take a longer break, do only part of the exam, or reschedule. Every option is acceptable.
"We can keep going, take a break, or stop for today. All of those are completely okay."
STEP 5 · CLOSE
Document & follow up
Record what happened and which adjustments helped, using neutral, non-judgmental language. Offer support resources and a follow-up plan, and debrief with the team.
"Thank you for telling me. I'll note what helped so next time is easier."