Original Report| Volume 32, ISSUE 3, P278-283, June 2019

Factors Influencing Adolescent and Young Adults’ First Pelvic Examination Experiences: A Qualitative Study

Published:November 02, 2018DOI:


      Study Objective

      To understand the factors that influence individuals’ experiences during their first pelvic examination.

      Design, Setting, Participants, Interventions, and Main Outcome Measures

      We conducted semistructured interviews with adolescents and young adults, aged 18-24, who had received at least 1 pelvic examination. Interviews explored contextual factors of the first pelvic examination, including visit acuity and clinical setting and individuals’ experiences with the pelvic examination itself and elicited recommendations on how to improve the examination experience. Interviews were transcribed and computer-assisted content analysis was performed; salient themes are presented.


      Thirty participants completed interviews. Nineteen participants described their first pelvic examination experience as positive; 11 described this examination as a negative or neutral experience. Factors influencing the experience include the examination indication and acuity, examination location and physical space, provider features, relational and interpersonal features, and procedural aspects. Recommendations included: (1) establish rapport and educate before the examination; (2) establish practices to orient patients; (3) make no assumptions about identity; and (4) elicit continuous feedback.


      Individuals’ first pelvic examination experiences are influenced by a variety of factors. Although some factors are directly modifiable by providers, other factors that might not be modifiable are important to elicit to optimize the examination experience. These findings call for best practice guidelines and educational interventions to prepare providers to perform the first pelvic examination.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Pediatric and Adolescent Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Committee on Gynecologic Practice
        Committee opinion No. 534: well-woman visit.
        Obstet Gynecol. 2012; 120: 421
        • ACOG Committee Opinion no. 598
        Committee on Adolescent Health Care: the initial reproductive health visit.
        Obstet Gynecol. 2014; 123: 1143
        • Wijma B.
        • Gullberg M.
        • Kjessler B.
        Attitudes towards pelvic examination in a random sample of Swedish women.
        Acta Obstet Gynecol Scand. 1998; 77: 422
        • Yanikkerem E.
        • Özdemir M.
        • Bingol H.
        • et al.
        Women’s attitudes and expectations regarding gynaecological examination.
        Midwifery. 2009; 25: 500
        • Hilden M.
        • Sidenius K.
        • Langhoff-Roos J.
        • et al.
        Women’s experiences of the gynecologic examination: factors associated with discomfort.
        Acta Obstet Gynecol Scand. 2003; 82: 1030
        • Bodden-Heidrich R.
        • Walter S.
        • Teutenberger S.
        • et al.
        What does a young girl experience in her first gynecological examination? Study on the relationship between anxiety and pain.
        J Pediatr Adolesc Gynecol. 2000; 13: 139
        • Grundström H.
        • Wallin K.
        • Berterö C.
        ‘You expose yourself in so many ways’: young women’s experiences of pelvic examination.
        J Psychosom Obstet Gynaecol. 2011; 32: 59
        • Fiddes P.
        • Scott A.
        • Fletcher J.
        • et al.
        Attitudes towards pelvic examinations and chaperones: a questionnaire survey of patients and providers.
        Contraception. 2003; 67: 313
        • Miles M.B.
        • Huberman A.M.
        • Saladaña J.
        Qualitative Data Analysis.
        3rd ed. SAGE Publications, London2014
        • Bernard H.R.
        • Ryan G.W.
        Analyzing Qualitative Data: Systematic Approaches.
        SAGE Publications, Thousand Oaks, CA2009
        • Gupta S.
        • Higan R.
        • Kirkman R.J.
        Experience of the first pelvic examination.
        Eur J Contracept Reprod Health Care. 2001; 6: 34
      1. Committee on Ethics, American College of Obstetricians and Gynecologists: ACOG Committee Opinion No. 373: Sexual misconduct.
        Obstet Gynecol. 2007; 110: 441
        • Committee on Practice and Ambulatory Medicine
        Use of chaperones during the physical examination of the pediatric patient.
        Pediatrics. 2011; 127: 991
        • Bryan A.F.
        • Chor J.
        Factors influencing young women’s preparedness for their first pelvic exam: a qualitative study.
        Obstet Gynecol. 2018; 132: 479
        • Oscarsson M.
        • Benzein E.
        Women’s experiences of pelvic examination: an interview study.
        J Psychosom Obstet Gynaecol. 2002; 23: 17
        • Goldstein L.S.
        • Chapin J.L.
        • Lara-Torre E.
        • et al.
        The care of adolescents by obstetrician-gynecologists: a first look.
        J Pediatr Adolesc Gynecol. 2009; 22: 121
        • Braverman P.K.
        • Breech L.
        • Committee on Adolescence: American Academy of Pediatrics
        Clinical report--gynecologic examination for adolescents in the pediatric office setting.
        Pediatrics. 2010; 126: 583
        • Daley A.M.
        • Cromwell P.F.
        How to perform a pelvic exam for the sexually active adolescent.
        Nurse Pract. 2002; 27: 28
        • Ricciardi R.
        The first pelvic examination in the adolescent: an update.
        J Nurse Pract. 2008; 4: 377
        • Beyth Y.
        • Hardoff D.
        • Rom E.
        • et al.
        A simulated patient-based program for training gynecologists in communication with adolescent girls presenting with gynecological problems.
        J Pediatr Adolesc Gynecol. 2009; 22: 79
        • Dumont T.
        • Hakim J.
        • Black A.
        • et al.
        Does an advanced pelvic simulation curriculum improve resident performance on a pediatric and adolescent gynecology focused objective structured clinical examination? A cohort study.
        J Pediatr Adolesc Gynecol. 2016; 29: 276