Standing or lying supine
If you wish to palpate on the skin, provide a private room. If you think this is necessary, the patient is asked if he/she is willing to lower his/her pants, if needed, for direct palpation on the skin or intervention related to the pubic symphysis. While the skin can not be viewed with clothes covering the area, the pubic tubercles and the area between the pubic tubercles, the pubic symphysis, usually can be palpated to assess pain response over clothing. For intervention, realignment of the pelvis and pubic symphysis by pressure on pubic tubercles may be possible over clothing.
Anterior to the patient.
Possible trauma or damage to the pelvic bones can be evaluated more accurately if you lower your pants (and demonstrate the level, which is to the level of the pubic tubercles). Would you feel comfortable doing this? If not, I can assess some things without moving your clothing and with pressure from my fingers. Please mimic where I place my hands on my own body (demonstrate pressing on the abdomen from your umbilicus down to your pubic tubercles). Your fingers will rest on bony ledges. May I replace your fingers with my fingers (or demonstrate)? (You can use a skeleton if available).
Guide the patient to drape and have them mimic your motions of pressing your fingers from the umbilicus to rest on the body ledges of the pubic tubercles. If given permission, replace the patientÃs fingers with your fingers.
This area of the body is very sensitive related to modesty. Allow adequate time for explanation and to request permission to touch and then to drape.
If this palpation is used to assess or intervene for pelvic symmetry/obliquity, ask permission to touch, and if permission is given, place your thumbs on the pubic tubercles. Compare levels of pubic tubercles (and therefore the pubic symphysis joint) in height and anteroposterior position as your thumbs are held equally extended and parallel to the floor. Evaluate the levels of the pubic tubercles and the area in between, the pubic symphysis, at eye level for height and from a superior view for anteroposterior assessment.
This area of the body is very sensitive related to modesty. Allow adequate time for explanation and to request permission to touch and then to drape.
If this palpation is used to assess or intervene for pelvic symmetry/obliquity, ask permission to touch, and if permission is given, place your thumbs on the pubic tubercles. Compare levels of pubic tubercles (and therefore the pubic symphysis joint) in height and anteroposterior position as your thumbs are held equally extended and parallel to the floor. Evaluate the levels of the pubic tubercles and the area in between, the pubic symphysis, at eye level for height and from a superior view for anteroposterior assessment.
VH - Pubic symphysis