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Gynaecological Examination

From Mediwikis

The Gynaecological examination includes three components- abdominal examination, bimanual examination, and examination using a speculum. This can be distressing for a patient, so act with empathy and respect towards the patient at all times. The bimanual examination is commonly assessed during the OSCE examination, and revising the technique is important to detect clinical signs.

Introduction

  • Introduce yourself
  • Wash your hands
  • Explain what you are going to do and gain consent.
  • You must always have a chaperone with you (preferably female) and write down who they are in the notes!

General Examination

  • General appearance
  • Height and weight (BMI)
  • Any scars, distension or visible masses
  • BP, pulse and urine dipstick (including a pregnancy test)
  • Facial and body hair

Abdominal Exam

You should perform an abdominal exam, looking for:

  • Masses
  • Tenderness

External Genitalia

  • Prepare all the equipment you are going to use now, to minimise the amount of time the patient is exposed and to make yourself look much more confident and competent then you probably are.
  • Expose the patient
  • Examine the vulva for redness, swelling, ulceration, warts and discharge
  • Examine the urethral meatus and ask the patient to cough - looking for signs of incontinence (do not be directly in front of the urethra at this point...)

Speculum Examination

  • Part the labia to minimise discomfort
  • Insert the speculum sideways first, then rotating it into the correct position.
  • Open the blades of the speculum carefully
  • Inspect the cervix looking for any tears, polyps, bleeding, discharge or warts
  • Perform any swabs or sweeps that you need to do
  • Carefully withdraw the speculum

Bi-manual palpation

Ask about any soreness or vaginisthmus

  • Part the labia to minimise discomfort
  • Insert your lubricated middle and index finger into the vagina up to the cervix
  • Put your other hand on the pubic symphasis, rocking the uterus against your fingers
  • Feel the uterus for its size, shape (should be the size and shape of a small pear) and if it is tender
  • Palpate the fornices feeling for ovarian enlargement
  • Cervix
    • Position
    • Size
    • Tenderness
    • Brush against the cervix for cervical excitation, warn the patient first

Completion

  • Cover the patient up and thank them
  • Dispose of used speculum, gloves etc.
  • Allow the patent to get dressed before explaining your findings