There are a few contraindications to the pelvic examination:

• When the patient refuses examination.
• When the patient has an imperforate or cribriform hymen, which makes pelvic examination impossible. Rectal examination is performed in this case.
• When the patient is mentally retarded and may not understand what is being done or why. Such patients may be very uncooperative. The examination is better performed under anesthesia in this situation.
• When the obstetric patient has known placenta previa (complete or marginal).
• When the obstetric patient has undiagnosed vaginal bleeding. In this case the patient should have sonographic evaluation to rule out placenta previa.

Barriers to obtaining a good examination that are not absolute contraindications to pelvic examination include the following:

• Obesity
• Difficulty positioning elderly or disabled patients
• Factors that interfere with collection of specimens
• Vaginal secretions for wet prep, potassium hydroxide (KOH), and cultures
• Papanicolaou smear
• Endometrial biopsy
• Colposcopy
• Fecal occult blood testing