Implementing a Vaginal Self-Swab Protocol at a Teen Sexual Health Clinic

Abstract

Problem Statement: Vaginal speculum exams (VSE’s) can inflict discomfort, anxiety, and psychological traumatization in adolescents. Vaginal specimens that are patient-collected by self-swab are equivalent to provider-collected specimens during a VSE for diagnosing gonorrhea, chlamydia, bacterial vaginosis, and yeast infections. Lacking a protocol for vaginal specimen collection by self-swab is a system barrier to providers consistently offering the option of specimen collection by self-swab.

Purpose: The purpose of this project is to increase the number of vaginal specimens collected by self-swab, decrease the number of speculum exams performed, decrease barriers to screening, and increase patient satisfaction and empowerment.

Background: There has been a recent movement in the area of Women’s Health to decrease unnecessary VSE’s. The few studies so far have not supported the value of the VSE in screening and diagnostic purposes, but have established their harms, especially for women who have a history of sexual assault. Adolescents make up 42% of sexual assaults putting them at higher risk of experiencing harms from a VSE.

Population: This protocol was implemented at a small teen sexual health clinic that predominantly serves adolescent females. It is standard of care that vaginal specimens to test for bacterial vaginosis and yeast infections are obtained by a VSE due to lack of a self-swab protocol.

Project Design: The project design is a protocol that includes a Self-Swab Eligibility Decision Tool to be used by providers and a Self-Swab Procedure for patients. The Eligibility Decision Tool walks the provider through yes/no questions based on evidence and expert opinion to determine clinically eligibility for self-swab. The procedure was created based on evidence and tailored to adolescents.

Evaluation: Data collected in the form of patient surveys, provider surveys, and documentation on the vaginal specimen (patient eligibility and adequacy of specimen collected) began in July and will continue until September when analysis will take place.

Conclusion: This patient empowerment protocol for self-swab is a pilot project that utilizes components of quality improvement and evidence-based practice to minimize harms and improve healthcare delivery and patient satisfaction.