Patient Guide to Sensitive Exams, Treatments and Procedures

St. Peter's Health has a core value of keeping colleagues and patients safe, in every sense of the word. We feel this policy upholds our values. Additionally, providing chaperones during sensitive examinations is recommended as best practice by the American Medical Association and has been adopted by healthcare institutions throughout the country.

Any physical exam, procedure or treatment involving the male or female genitals or rectum or female breasts is considered “sensitive.” These include: 

• Female breasts 
• Pubic/groin region (for a hernia) 
• Vulva and vagina 
• Penis and scrotum 
• Rectum 

For sensitive encounters, you can expect: 

• An explanation of the exam, including why it is needed, what the provider will do, and what it may feel like.
• Privacy to undress. You will typically be given privacy to undress whenever possible, unless assistance is needed for safety or medical reasons. 
• You will typically should be offered a covering (gown or sheet/drape) if your body is exposed. Your care team will only uncover the parts of your body that need to be examined and keep them uncovered for the shortest time necessary to allow for appropriate examination.
• Staff or providers will not make sexual remarks, hints or jokes. 
• Your care team will communicate with you using anatomical terminology instead of slang words and common lingo. While these words may not be the words you would use to describe your body and your behaviors, these words best communicate our respect for your body and your experience. 
• You have the right to refuse any portion of an exam or stop it at any time. If you feel uneasy at any time, speak up. You are in charge of your body.

The chaperone is a specially trained member of the St. Peter’s Health team. Their job is to ensure patient and provider comfort, safety, privacy, security and dignity during these exams or procedures. The chaperone will stand in a location where he or she can observe what is going on and assist our patients and providers as needed.

Yes. Patients may request a chaperone during any visit and for any reason. We commit to provide a chaperone when one is requested by the patient or clinician. To request a chaperone, simply tell your attending care team that you wish for a chaperone to be present.

Yes. We are committed to providing chaperones in a way that is comfortable for our patients. If you feel uneasy or you need more information about what will happen during your exam, please ask us. We are here to help you prepare for medical care that requires a chaperone. In non-urgent settings, if you choose to decline a chaperone, the exam may be rescheduled based on clinician judgment. Chaperones are a healthcare best practice and assist both patients and clinicians in completing visits in a consistent, safe and respectful manner.

Yes. Patients may request a chaperone of a specific gender, and we will attempt to accommodate that request. If we are unable to accommodate, the patient may choose to move forward with the visit with a chaperone not of their preferred gender, or may reschedule to a time when sufficient staffing is available.

Yes. Routine care, including but not limited to personal hygiene assistance, perineal checks during the labor and delivery experience, placing EKG leads, conducing an echocardiogram and similar care protocols do not require a medical chaperone. However, a patient or clinician may request a chaperone at any time and for any reason.

In emergency situations, some examinations or procedures may need to be performed quickly to ensure patient safety. While we strive to provide a chaperone whenever possible, urgent medical needs may require proceeding without delay.

A clinical breast exam is done to evaluate the breasts for changes or problems. Breast exams are recommended if you report a symptom or concern, such as a breast lump, rash, nipple discharge or breast pain. If you have a family history of breast issues or are at an age when breast cancer screening is recommended, your clinician may also recommend a breast exam. Lastly, if you have questions as to how to perform your own breast exam, your clinician may do a breast exam to educate you on how to monitor your breasts.

The provider will first look at your breasts and then feel your breasts, your underarm area, and the area below your breast bone as part of the exam. Your clinician may first inspect your breasts visually, oftentimes when you are sitting and then laying on your back. Your clinician might ask you to raise your arms above your head or bend forward to assess for changes in your breasts as you change position. Then, your clinician will ask you to lay back and put one arm above your head. They will use their fingertips to check your whole breast tissue for abnormalities that aren’t visible, and will also check under your arms for any enlarged lymph nodes. At times, a provider may need to squeeze your nipple to check for discharge.
 

• Expect an explanation before all breast exams.
• Unless a medical condition, physical characteristic, or concern exists, it is not appropriate for the provider to comment on the aesthetic appearance of breasts.
• Patients only need to undress from the waist up for a breast exam.
• Gloves may be worn based on clinical judgment.  
• A provider may need to move your hair behind your shoulders or move a necklace to the back to better see your breasts. These gestures will typically be explained to you.
• You have the right to refuse any portion of an exam or stop it at any time. You are in charge of your body. 
   

Mammograms

What to expect: 

• A technologist will guide you through each step and position your breast on a flat imaging plate. 
• Your breast will be gently pulled forward and positioned to include as much tissue as possible, including near the chest wall. 
• You may feel pressure or discomfort, but it lasts only about 5–10 seconds per image. 
• You will be asked to hold very still and briefly hold your breath while each image is taken. 
• Typically, 2–4 images are taken per breast from different angles. The technologist will reposition you between images.

Breast MRI

What to expect: 

• If contrast will be used for your study, you will have an IV placed prior to positioning you on the table. 
• You will be positioned face down on a padded table with cushioned openings designed to comfortably position the breasts without compression. 
• Your arms will be positioned above your head or at your sides, and you’ll be made as comfortable as possible to remain still. 
• The table will slide into the MRI scanner. 
• The machine will make loud knocking noises (ear protection will be provided). 
• If contrast is used, it will be injected through your IV during the exam; you may feel a cool sensation in your arm. 
• You will need to lie very still for 30–45 minutes.

An exam of the vulva and vagina is often called a pelvic exam. A pelvic exam is recommended when you have symptoms such as vaginal pain, itching or sores, abnormal vaginal discharge, abnormal vaginal bleeding, or pelvic pain. Sometimes, urinary symptoms also require a pelvic exam to help evaluate their cause. Pelvic exams are also routinely done when you have no symptoms but are due for cervical cancer screening – recommended starting at age 21. It may involve both an external and internal inspection as well as touching. Pelvic exams are used to screen for cancer, collect samples if an infection is suspected or to help diagnose if there is bleeding, pain or other symptoms. 

You will be undressed fully from the waist down and will have a drape to cover your abdomen and legs. You will be laying on the exam table with your bottom at the edge of the table and your legs open with the heels of your feet resting in supports called stirrups. For some people, this can feel awkward or vulnerable, so make sure you are checking in with yourself and your clinician. It is crucial that you feel in charge of what happens to your body. Your clinician will be wearing gloves throughout this entire exam and will tell you what they are going to do before they do it. In general, the first step is to visually inspect the outer vagina (the skin and pubic hair region, then the vulva, including the labia, the clitoris, the vaginal opening), the area between your vagina and your anus (perineum), and your anus. They will then examine the inside of your vaginal canal using a speculum, which is an instrument shaped like a duck’s bill that will be put into the vagina and opened just enough to provide full visualization of the sidewalls of the vagina and the cervix. Sometimes your clinician will need to reposition you or the speculum to ensure full visualization. Your clinician may take samples of the cells of your cervix using a soft plastic brush (a pap test) or samples of the fluid within your vagina using a Qtip-like brush (to test for infections and yeast/bacterial overgrowth). In some circumstances, your clinician might recommend a “bimanual examination.” This is an examination to evaluate your internal pelvic organs (uterus, ovaries, fallopian tubes, etc.). Your clinician will stand at your feet then put one or two gloved fingers into your vagina to stabilize your uterus while using the other hand to push down lightly over your lower abdomen to check for tenderness and to assess the size and position of your pelvic organs. 

• Expect an explanation before all pelvic exams. 
• Unless there is a medical condition or concern, it is not appropriate for a provider to comment on the aesthetic appearance of a patient’s vulva or vagina. 
• The provider will wear gloves. 
• The exam will be performed using appropriate clinical technique and only as long as necessary for evaluation
• A duck bill-shaped plastic or metal instrument, called a speculum, is often used for the internal vaginal exam. The provider will typically advise you before inserting it. You can expect it to be gently inserted and opened to provide visual access into the vagina. 
• Routine vaginal exams (with a speculum) are typically not required until age 21, unless the patient has specific symptoms, conditions or has medical risks. The patient’s doctor will typically discuss risks with them prior to the exam. 
• During pregnancy, pelvic exams are routinely performed during the first visit, during the last trimester, and if there are any changes in the patient’s health or that of the baby. 
• You may refuse any part of the exam or ask for it to be stopped at any time. You are in charge of your body.

Transvaginal Pelvic Ultrasound

What to expect:

• You will be given privacy to change and will lie with your knees bent and feet supported, similar to a pelvic exam. 
• A thin, covered probe will be gently inserted into the vagina.
• The technologist will move the probe slightly to obtain different views. You may feel pressure but should not feel pain.
• You can ask to pause at any time if you feel uncomfortable.

Cystogram

What to expect:

• You will lie on an exam table while the genital area is cleansed to maintain sterility.
• A thin, flexible catheter will be gently inserted through the urethra into the bladder, this may cause brief discomfort or a pressure sensation.
• Contrast dye will be slowly introduced through the catheter to fill the bladder.
• As your bladder fills, you may feel increasing fullness and a strong urge to urinate.
• X-ray images are taken at different stages of filling. In some cases, you may be asked to urinate while images are taken to evaluate bladder function.
   

A rectal exam may be necessary to make a diagnosis for patients who have symptoms, including but not limited to lower abdominal pains, unusual lower back pains, urinary discomfort, blood in your stool, any symptoms on your buttocks or around your anus such as rashes, sores, lumps, itching, discomfort, or swelling. It may also be necessary to collect a sample to run a test for suspected sexually transmitted diseases of the rectum. 

Depending on what you are wearing, you may be asked to undress and given a drape, or asked to move your clothes aside for the exam. Depending on your symptoms, you may be asked to lie on the exam table on your side with your knees curled into your chest or you may be asked to stand and bend over the exam table. Types of rectal exams include: 

External rectal exam 
The provider will visually examine the anus and the area around the anus. Using gloved hands, your provider will examine the skin of your buttocks then gently spread your buttocks and anal tissue to allow a thorough visual inspection. They will then use their finger to manually inspect the outer anal tissue. They look for sores, rashes or other lesions. The chaperone or a medical assistant may be asked to move a light so the provider can see the area better. If testing for infections, a swab may be placed about 1 inch into the anus/rectum, rotated gently, and then removed. 

Digital rectal exam 
The provider inserts one gloved and lubricated finger into the anus to feel for any lumps or anything abnormal. They may also push firmly on the prostate gland, if present, to check for pain, tenderness or nodules on it. It is normal and routine to be asked to push, strain or bear down as if having a bowel movement during a digital rectal exam. 

Anoscope exam 
To examine the rectum inside, the provider may insert a lubricated rigid, hollow tube (about an inch wide) called an anoscope, into the anus. The chaperone or medical assistant may be asked to move a light so the provider can see the area better. If necessary, your clinician may use a small swab to collect cells or fluid from inside the anus for laboratory analysis. 

Imaging Exams Requiring Rectal Contrast 
What to expect: 

• You will lie on an imaging table, and a small, flexible tube will be gently inserted into the rectum. 
• A contrast material (barium, gastrografin, or similar) will be slowly introduced into the colon through the tube. 
• You may feel a sense of fullness, cramping, or the urge to have a bowel movement, this is normal. 
• In many cases, air will also be introduced to expand the colon for clearer images, which may increase the sensation of pressure. 
• The technologist will ask you to turn into different positions to distribute the barium throughout the colon. 
• X-ray images will be taken throughout the process. These exams typically last 20–30 minutes. 

You may refuse any part of the exam or ask that it be stopped at any time. You are in charge of your body.  

The penis, testicles and/or scrotum may be examined if a patient is having pain, swelling or discharge, has sores or other symptoms, or as part of a normal skin and physical exam. It may also be done to check for a hernia. 

You may be lying on the exam table or standing, depending on what your symptoms are. You will typically be asked to lower your shorts or pants. Your clinician will be wearing gloves for this exam. They will start by visually inspecting your penis and scrotum. If your penis is uncircumcised, your clinician may ask you to retract your foreskin to allow full visualization of the penis. They may also need to reposition your penis or touch the tip of your penis to check for discharge. 

Your clinician will then feel the contents of your scrotum, including your testicles. Occasionally, special tests will be performed, such as shining a bright light through the scrotum to look for fluid or lightly touching the inner thigh to observe for a reflexive retraction of the testicle. And if there is any discharge from the urethra, a sample of it may be collected for laboratory analysis. 

It is not rare to experience an erection with this examination, as erections can be triggered by anxiety or as a simple reflex to touch. If this happens, please know this is very normal. 

• Expect an explanation before all exams. 
• Unless there is a medical condition or concern, it is not appropriate for a provider to comment on the aesthetic appearance of a patient’s penis, scrotum or testicles. 
• The provider will wear gloves when feeling the penis and testicles. 
• You may refuse any part of the exam or ask for it to be stopped at any time. You are in charge of your body.

Penis exam 

• During this part of the exam, the provider will look and touch the penis. This includes the skin, moving the foreskin, touching the tip and urethra (the urine opening in the penis). 
• If the patient is not circumcised, the provider may ask them to pull back the foreskin or the provider may do this to look for sores and problems. 
• The provider may feel and press all surfaces of the penis, to check for sores or problems. 
• The provider may examine the opening of the urethra, called the urethral meatus. They may use a swab to gently collect a sample of any discharge. 
• The provider may press along the shaft of the penis to see if any fluid discharges. 

Scrotum and testicle exam 

• During this part of the exam, the provider will do a visual and hand exam of the testicles and scrotum. 
• The provider may feel the testicles for size, irregularities and tenderness. 
• The provider may also feel along the spermatic cord, which contains the spermatic artery and vein, looking for any problems. 
• This exam generally takes about 2-3 minutes. 

Testicular Ultrasound 

What to expect: 

• You will lie on your back, and towels or a supportive sling may be used to position and stabilize the scrotum. 
• Warm gel will be applied to the skin to help transmit sound waves. 
• The technologist will gently move a small probe over the scrotal area, sometimes applying light pressure to examine specific regions. 
• You may be asked to remain still or briefly hold your breath. 
• The exam is not painful, though slight discomfort or sensitivity is possible if the area is already tender. 

Hysterosalpingogram/ Hysterosongram 

What to expect: 

• You will be given privacy to change and will lie with your knees bent and feet supported, similar to a pelvic exam. 
• A speculum will be inserted into the vagina to visualize the cervix. 
• A small catheter will be placed into the uterus. 
• Fluid (dye or saline) will be injected. 
• As the dye or fluid fills the uterus and fallopian tubes, X-ray or ultrasound images will be taken in real time. 
• You may feel cramping or a sensation of fullness as the uterus expands this can range from mild to moderate and typically lasts only a few minutes. 
• You may be asked to change position slightly to help visualize the fallopian tubes. 
• Cramps and spotting is normal for 1-2 days after the exam. 

Cystogram 

What to expect: 

• You will lie on an exam table while the genital area is cleansed to maintain sterility. 
• A thin, flexible catheter will be gently inserted through the urethra into the bladder, this may cause brief discomfort or a pressure sensation. 
• Contrast dye will be slowly introduced through the catheter to fill the bladder. 
• As your bladder fills, you may feel increasing fullness and a strong urge to urinate. 
• X-ray images are taken at different stages of filling. In some cases, you may be asked to urinate while images are taken to evaluate bladder function.

This exam is generally recommended when you have a symptom in the area, like a rash, an itch, or discomfort. It is also performed if your clinician needs to check for hernias or needs to check the arteries providing blood flow to your legs (such as for a sports physical) or for swollen lymph nodes. A hernia is a weak spot where bowel might squeeze out. They are common in the groin area. 

You may be laying on the exam table or you may be standing up for this exam. Depending on what you are wearing, you may be asked to undress and given a drape or shorts to wear, or you may be simply asked to move your clothes slightly away from the area to be examined. Your clinician will visually inspect the skin (sometimes using a magnifying glass) then palpate the area with the gloved fingers. 

• The provider will do a complete visual exam of the scrotum, groin and hip crease to look for any problems. 
• The provider will feel the groin, inner upper thigh crease, lower abdomen and hip area. They will feel the testicles, where there are lymph nodes and the spermatic cord inside the scrotum. 
• During a hernia exam, while the patient is standing or lying down, the provider will place his or her fingers up against the abdominal wall and scrotum. The provider may ask the patient to cough or bear down to increase the abdominal pressure to see if they can feel the weak spot or opening. 
• Gloves may or may not be worn when the provider feels the patient’s abdominal wall, unless there is risk of coming into contact with open wounds, blood and/or bodily fluids. 
• You can refuse any part of the exam or ask that it be stopped at any time. You are in charge of your body.

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