If a female patient has a history of vaginal discharge with odor, ask if she uses tampons. If she says “yes,” when conducting the pelvic exam, do not enter the vagina in the same way that you would to take a pap smear. Instead, start shallow rotating of the speculum from side to side until reaching the cervix. Most retained tampons are lodged in the fold between the outer cervix and the upper vagina. I have retrieved several tampons even after the patient has been seen by another provider and had a speculum exam, and the tampon is still there. If you go in directly to the cervix and open the speculum, you will compress the tampon and not see it.—DEBORAH BRYSON, FNP, Clifton, Va. (203-3)



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