Given the high incidence of sexual abuse (often undisclosed), what is the best way to perform a physical examination (especially a pelvic) without inducing anxiety?—CATHERINE LeBLANC, PA, Framingham, Mass.

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An effective patient-clinician relationship is important prior to any physical exam, especially one that involves intimate contact. A foundation of trust and a nonjudgmental and caring environment will help alleviate anxiety associated with the pelvic exam. Before beginning, the clinician should explain each step of the process, show the instruments that will be used, and encourage the patient to ask questions or share her concerns. Charts and plastic models can also be helpful. If there is no sign of an acute problem, a follow-up visit reserved for continued counseling may be more appropriate. In cases involving suspected sexual abuse, the key component of the initial encounter is building a relationship of trust. It is important to get a sense of the patient’s level of anxiety and alleviate it as much as possible while working to build a successful relationship that encourages regular follow-up and communication.—Claire Babcock O’Connell, MPH, PA-C (146-16)