Exam - Gynaecology

Exam

·        Explanation while dressed.  Check experiences with past exams

·        Ensure chaperon if male

·        Have available: light, additional light source and mirror for the patient

·        Check bladder is empty

·        Clear instructions to patient on what clothes to remove and position.  Cover with sheet 

·        Position: flat on back on firm surface, unless prolapsed, obese or on a soft bed, in which case left lateral position (like recovery position) with right knee drawn up 

·        Pulse: indicator of anxiety

·        BP

·        General physical exam as indicated

·        Vaginal Exam: 

o   Bivalve Speculum: warm and check temperature. Introduce at 45 degrees then rotate. Use narrow speculum for nulliparous, wider speculum for multiparous, and paediatric for child or sometimes post menopausal. Use Sim‟s Speculum for prolapsed. Warm blade, little (preferably no) lubricant if doing a smear. 

o   Check size, shape, position and appearance of cervix, view transformation zone and os. Nulliparous or multiparous cervix

o   Bimanual:

§  Check uterus for size, shape, consistency, tenderness and mobility

§  Check adnexae for abnormal swelling or tenderness

§  Normal tube and ovaries are not palpable

·        Explain results when fully dressed