Glad to see you are out and practicing. Wondering about the "lub" we were taught
lub interferred with the pap results so we only use H2O.
I have to agree...none of us cares to be on that table. Depending on your patient you can really make it a fun time. There have been times that the laughter has been so loud people wonder just what is going on in there!
I frequently use lube for pap smears, especially for perimenopausal or menopausal women. The trick it to use a small amount...just enough to get the speculum to slide easily. Another tip...if possible use something like "Slipper Stuff" or "Fem Glide". It's actually nicer for women and does not end up sticky-icky like ky jelly.
Oh yeah...have a good size hand held mirror available...it's great when they want to see or when you need to show them something.
I have had a few early paps come back from too much lubrication Azygos. That's why I've cut WAY back on it. I never thought about using water. I'll have to try that sometime.
Great tips Barbara! I had a student with me the other day in the office and she said that they are teaching them to have mirrors for that reason. I think that it's great!
*IF* I go with my original plan and go on to be an NP, I would be working in an OB/GYN office (my Doc offered me a job when I talked to her about going back to school!). I'm wondering though...when you talk with the patients before the exam, do you ask about any abuse history? The exam is hard for everyone, having an abuse history makes it nearly impossible. I was fortunate, I had a very compassionate (and pushy) GP. When my lab results came back severely bad (CIN III HSIL), she referred me to a GYN who turned out to be great with survivors. I know there are several women out there who don't do this exam at all because of their histories (one of them is a friend I am trying to get to go). And I am rambling here...not sure what my point is!
Sera
My GYN has a NP who works in his office. She is far more sensitive and personable than he could ever be. Continued success with your good work. Women need more NPs like you.
Sera, I have been asking patients during their exams if there is any problems because it's the one exam that partners usually don't go into. We must also make sure not to assume that same sex partners get the same screening. Abuse in any form is a horrible thing to have to endure. I am a survivor of childhood abuse myself.
Thanks Terry! I hope to continue to help as many as possible.
pap smear...it sure looks scary with that speculum...
good thing you have the power to make it comfortable, easy and fun
cheers =)
ooo! you go girl! i like to try to pass off little tips like that to john (my boyfriend - he's an ob/gyn); things that only a woman would know about having an exam. do you touch the speculum to the inside of their thigh before putting it in? i had someone do that once and it helped calm me for some reason. i think your way of doing things sounds great! when can i make my appt? 
As a male FNP student, I'm acutely aware of my limitations in this area of practice. I currently have a clinical at a high-volume OB/gyn practice and one at a family practice. This week I performed my first complete pap and bimanual exam on a patient (as opposed to a paid model). We both survived. 
... but I have a looong way to go before I achieve competence.
I know I'll never be able to intuitively relate to a woman's experience in the exam room, so I value every tip from my teachers, classmates, and friends -- and great blog entries like this one -- in the hope of making the process less traumatic and less mysterious for my patients. I'm looking forward to a time where my comfort level is high enough to carry on a fluid conversation throughout the whole visit, history to handshake. I'm lucky to have fantastic preceptors (and patients!).
Thank you for the advice. (I am currently in an NP program in Illinois). What an excellent blog this is.
Rich, Those speculums do look scary, don't they?
Tofu, I remember someone mentioning that trick to me once about touching the inside of the thigh first. That's a great idea! Thanks for the vote of confidence!
D.D. Having great preceptors can make a world of difference. Just remember to treat people you are examining as you would want to be treated yourself. Works every time! Glad you find my site helpful!
Jane, I'm glad you like my blog! Take full advantage of different clinical sites. It helps to be well rounded at the end.
I happen to know of a NP who uses mini headlamps for better lighting.
I think it's great that you include "small talk" during the procedure. It is such an uncomfortable situation for everyone involved at times (IMHO), and yet, if the examiner takes the time to ease the situation via communication, it really does help. Kudos to you.
Michelle, it does help to have some small talk. You get to know your patients much better that way.
Commenting by HaloScan
