Bimanual examination

Question 1

Bimanual exam - Introduction

Answer 1

• Wash hands
• Introduce
• Check patient identity
• Explain procedure
• Gain consent
• Offer chaperone
• “Do you need to empty your bladder before the procedure?”
• Undress (offer privacy and sheet)
• Position
  
  • “Bring your heels towards your bottom and let your knees fall to the side”

Question 2

Bimanual exam - General inspection

Answer 2

• Comfortable at rest? Obvious pain?
• Polycystic ovary syndrome
  
  • Hirsutism
  • Acne
  • Increased BMI
• Cachexic

Question 3

Bimanual exam - Inspection

Answer 3

• Put sterile gloves on
• Part the labia and inspect for:
  
  • Urethra and vaginal orifice
  • Inflammation
  • Discharge or blood
  • Ulceration
  • Atrophy
• Ask patient to cough/bear down to assess for prolapse or stress incontinence

Question 4

Bimanual exam - Palpation

Answer 4

• Insert lubricated index finger with palm upwards. If well tolerated, introduce both index and middle fingers
  
  • Feel walls of vagina for smoothness and swellings
• Locate cervix (should be smooth, mobile, non-tender)
• Gently move cervix side to side, looking for any excitation (tenderness)
  
  • Pain is elicited on the ipsilateral side
    
    • Pelvic inflammatory disease
    • Ectopic
    • Endometriosis (pouch of Douglas)
• With fingers behind the cervix, push up while pushing down on the fundus of the uterus
• Palpate adnexa for any enlargement or tenderness (ovaries)
• Remove fingers, and inspect for blood or discharge
• Offer tissue

Question 5

Bimanual exam - Complete examination

Answer 5

• Pelvic ultrasound
• Pregnancy test
• Bloods (hormone levels, FBC)
• Dipstick urine
• Vaginal swabs