Utilization of a Mirror During Pelvic Examinations: Does it Improve the Patient’s Experience?

Abstract

Objective This study was conducted to assess the utility of a mirror in improving pain and vulnerability during a pelvic examination. Methods In this prospective, institutional review board-approved, 2-cohort trial, all “new” patients presenting to a urogynecology office were offered to have a mirror or no-mirror present during their pelvic examination. Patients completed 100-mm visual analog scales regarding pain, anxiety, knowledge, control, embarrassment, and vulnerability before and after examination. The primary outcome was difference in level of pain and vulnerability between groups. Secondary outcomes included comparisons from baseline to postexamination scores within groups, patient satisfaction, and examination duration. A sample size of 68 participants in each arm was planned. Results From April 2019 to May 2020, 147 participants were enrolled. Two participants were excluded, 145 were included in the final analysis; 74 in the no-mirror group and 71 in the mirror group. The average age was 55.9 (±13) years, and the groups were overall similar. There was no difference in primary outcomes of pain or vulnerability, but the mirror group showed improved levels of control (P = 0.006) and knowledge (P = 0.018) following examination. All participants reported high satisfaction, and those that selected a mirror reported strong preference for future use. Conclusions Patients who chose to use the mirror did not demonstrate a difference in pain or vulnerability scores; however, they exhibited benefit to their sense of control and knowledge after the pelvic examination. Although the mirror did not benefit all patients, this is a simple option that could improve the examination experience for some. Clinical Trial Registration: ClinicalTrials.gov, NCT03785548

A practical guide to the trauma-informed physical examination

“…Some patients may prefer to have a mirror so that visual input is maintained. 22 Verbally prepare the patient before starting the examination, especially if the patient cannot see what is being done. Cue the patient about different sensations, such as when the patient will be touched by something cold, vibrating, or sharp.…”

“…During pelvic examinations, the head of the examination table should be elevated slightly so the patient is not completely supine and unable to see the clinician. Some patients may prefer to have a mirror so that visual input is maintained 22. Verbally prepare the patient before starting the examination, especially if the patient cannot see what is being done.…”