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Environment

Room Setup & Environmental Recommendations

The room tells the patient whether they are safe before anyone speaks. Small, low-cost changes can lower anxiety and give the patient more control.

Entry & Privacy

  • Position the table so the patient’s feet do not face the door.
  • Use a privacy curtain inside the door and a clear "exam in progress" sign.
  • Knock, wait for an answer, and say who you are before entering.
  • Give the patient a private space to undress, with a hook or chair for their belongings.

Lighting & Sensory

  • Use warm, dimmable ambient light and only use the exam lamp when needed.
  • Keep the room warm and offer a heated blanket or a second drape.
  • Keep instruments covered until they are needed and show them before use.
  • Offer headphones, a fidget, or a focal image as grounding tools.

Table & Positioning

  • Use an adjustable backrest that can stay raised for eye contact.
  • Pad the footrests, or offer to skip them entirely.
  • Use full-length drapes large enough to cover the patient’s knees.
  • Keep a hand mirror within reach of the patient.

People & Placement

  • Keep the number of people in the room to the minimum needed, and introduce each by name and role.
  • Ask the patient before trainees join, with no pressure to say yes.
  • Place the chaperone where the patient chose (head/shoulder or doorway).
  • Allow a support person of the patient’s choosing.

Recommendation

Stirrup-Free Exams

I recommend skipping stirrups for most pelvic exams unless the patient prefers them. Both setups below give patients more comfort and control, and still leave room for the speculum handle.

Side view of an exam table without stirrups: backrest raised, patient lying back with knees bent and feet resting flat on the pulled-out leg extension.
  1. 1Backrest up for eye contact
  2. 2Feet rest flat, no stirrups
  3. 3Leg extension pulled out

On an exam table

Use the table's leg extension instead of the stirrups, so the patient can rest their feet on the table surface.

Side view of a stretcher: two to three folded bath blankets under the patient's hips, knees bent, and feet flat on the mattress.
  1. 12–3 folded bath blankets under the hips
  2. 2Feet closer to buttocks = more tilt

On a cart or stretcher

Common in the emergency department. Have the patient move toward the end of the bed and place 2–3 folded bath blankets, or a commercial positioning wedge, under their hips. If you need more pelvic tilt, ask the patient to bring their feet closer to their buttocks.

View from the foot of the exam table: the patient's knees are covered by a drape, feet rest on the leg extension, and the clinician's hands rest outside the knees to show how far to open.
  1. 1Your hands rest outside the knees
  2. 2Drape over the knees
  3. 3Feet on the extension

Helping the patient open their knees

Never push a patient's knees apart. Keep the knees draped, rest your hands just outside them, and let the patient move to meet your hands.

“Let your knees fall apart until they are touching my hands.”

An upside-down bedpan crossed out: avoid using it under the hips.

Positions to avoid

An upside-down bedpan under the hips can feel unstable. Asking patients to put their fists under their hips restricts their hands and can feel like restraint.

The evidence

In a randomized trial of 197 women, those examined without stirrups reported a lower sense of vulnerability than those examined with stirrups (Seehusen et al., BMJ, 2006).

More examples of stirrup-free positioning from The Feminist Midwife.

Equipment worth knowing about

Ceek Women's Health Nella NuSpec speculum

Any speculum can be used for a trauma-informed exam. If your site has one, the NuSpec is a more trauma-informed option: a reusable speculum much smaller than standard models, named one of TIME's 100 Best Inventions of 2020. Ceek also sells single-use lights designed for it.

Visit Ceek Women's Health

Listed for information only; no sponsorship or endorsement.

Pre-Exam Room Checklist

Go through this list before bringing the patient in.

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