Position of the Patient and Examiner

POSITION OF THE PATIENT AND EXAMINER

The patient is asked to sit at the edge of the examination table and an opened draping sheet is placed over the patient’s knees. If a patient requests that a drape not be used, the request should be honored.

Positioning the patient for examination begins with the elevation of the head of the examining table to approx-imately 30 degrees from horizontal. The physician or an assistant should help the patient assume the lithotomyposition (Fig. 1.4). The patient should be asked to lieback, place her heels in the stirrups, and then slide down to the end of the table until her buttocks are flush with the edge of the table. After the patient is in the lithotomy po-sition, the drape is adjusted so that it does not obscure the clinician’s view of the perineum or obscure eye contact be-tween patient and physician.

The physician should sit at the foot of the examining table, with the examination lamp adjusted to shine on the perineum. The lamp is optimally positioned in front of the physician’s chest a few inches below the level of the chin, at approximately an arm’s length distance from the per-ineum. The physician should glove both hands. After con-tact with the patient, there should be minimal contact with equipment such as the lamp. Removing the speculum from the drawer prior to touching the patient will help to prevent contamination of other speculums and equipment (e.g., table, drawers, and lamp).