Learning Objectives #
1. To understand the different components of a thorough pelvic examination
2. To learn about the importance of preparation and communication during a pelvic examination
3. To learn which instruments and equipment are needed for a complete pelvic examination
Introduction #
Physical examination of female genitalia
This video will demonstrate how to perform a comprehensive pelvic examination. We will focus on communication skills, preparing for the exam, inspection of external genitalia, speculum examination, and bimanual examination. The video is divided into six learning modules as follows:
1- Introduction and preparation for the examination of the female genitalia
2- Inspection and palpation of external genitalia
3- Speculum examination
4- Preparing a pap smear
5- Evaluation of a patient with pelvic organ prolapse
6- Bimanual Examination
7- Pelvirectal examination
8- Concluding the physical examination of the female genitalia The objectives will be discussed at the beginning of each module.
When to Perform a Pelvic Examination:
A pelvic examination should be part of any woman’s routine physical examination. Women should also undergo a pelvic examination when they have signs or symptoms pelvic disease, or during the first prenatal visit of every pregnancy. Regular annual Pap smears: o Are recommended within two years of onset of sexual intercourse. This includes:
1. genital fondling
2. penile penetration
3. anal sex
4. oral sex
5. use of sex toys
6. other modes of sexual activity that allow for sharing of genital fluids
Preparation for the Examination:
Ideally, the patient should be interviewed in an office setting, fully clothed, prior to being brought into the examination room. The procedures should be completely explained in the office setting with time to address patient’s questions. Often it is helpful to ask if there is anything you can do to make the examination easier for the patient.
In the examination room:
The patient should then be brought to the examination room and given specific instructions on what pieces of clothing to remove, where to put them, and how to put on the sheet or gown provided. Finally show her where to sit when she is ready and tell her approximately how long she can expect to be waiting for you to return. Provide some privacy as the patient changes into a gown. Ensure the patient has emptied her bladder before the exam as a full bladder may compress the vaginal canal and obstruct the view of the cervix.
Before Starting the examination:
You will need to gather the following materials:
1. speculum
2. gloves
3. water-soluble lubricant
4. Auers spatula
5. glass slides and swabs
- Gloves should be worn for the examination of the female genitalia.
- Ensure that the examination light is working.
- Check that the speculum bills approximate where the speculum is closed, and that the screw on the speculum thumb piece is functional .
- Fibro-optic lights can be used for disposable specula.
- It is often helpful to offer a hand mirror to your patient so that they can observe the external genitalia.
- It is an invaluable opportunity for you to educate your patient about their external genitalia and discuss the findings during the examination.
- It is also extremely helpful for many women to feel more in control of what is being done during the examination.
Starting the examination:
- When you are ready to proceed with the examination help your patient into the correct lithotomy position. This is generally with her buttocks slid down the examination table to the point in the table that will swing down, and her feet guided into the foot rests.
- The head of the examination table should be elevated so that eye contact between the physician and the patient can occur.
- She should be draped in such a way that allows for minimal exposure but enables the physician to easily visualize her vulva while still keeping her knees covered.
- The examiner should be seated on a stool between the legs of the patient.
- In patients who are having their first examinations done, or have had difficulties previously, it is important for them to understand that at any time, if they want you to stop, you will.
- Sometimes it is helpful to suggest doing the complete exam over a few visits. It helps your patient feel that she shares in the control of the examination.
- Communication is the key to a successful pelvic examination.
- Eye contact also decreases the patient’s anxiety. A relaxed patient means a more accurate examination.
CyberPatient #
Cyber Patient is an area within a module that combines Flash animation with quiz or diagnostic questions. Its content varies in complexity from module to module.
Physical examination of female genitalia
This video will demonstrate how to perform a comprehensive pelvic examination. We will focus on communication skills, preparing for the exam, inspection of external genitalia, speculum examination, and bimanual examination.
The video is divided into six learning modules as follows:
1- Introduction and preparation for the examination of the female genitalia
2- Inspection and palpation of external genitalia
3- Speculum examination
4- Preparing a pap smear
5- Evaluation of a patient with pelvic organ prolapse
6- Bimanual Examination
7- Pelvirectal examination
8- Concluding the physical examination of the female genitalia
The objectives will be discussed at the beginning of each module.