Bimanual Examination Flashcards
What are the steps?
Introduction and identification
Explanation
Exposure
Position patient correctly
Put non-sterile gloves on
Inspection
Palpation
Complete the examination
Dispose of gloves in clinical waste and clean hands
Introduction and Identification
Give your name and status
Ask patient for name and DOB
Explanation
Explain to patient what you wish to examine, the purpose of the examination and any procedures that will also be performed if indicated
Inform that a chaperone will be present and check this is alright
Exposure
Request patient removes underclothes, in private and preserves modesty with sheet, advises when ready
Ask if patient would like to go to the toilet before you start
Position the patient correctly
Instruct patient to lie on back, knees bent and apart if on couch or in leg rests if gynaecology couch; adjust lighting
Check patient comfort
Put non-sterile gloves on
then
Ask patient to remove modesty sheet
Inspection
- Hair distribution
- Skin abnormalities
- Discharge
- Swelling
- Prolapse
If examining for prolapse or incontinence, ask patient to cough - note incontinence or prolapse
Palpation
Check with patient if any tenderness
Lubricate index and middle finger with small amount of water-based gel
Gently insert into vagina, feel for cervix, note findings (know what to look for)
Feel in posterior fornix and lift uterus anteriorly, Place other hand on lower abdomen, press gently as If finger tips from both hands could meet
Note size (equivalent weeks’ gestation) and mobility of uterus (anteverted anteflexed?)
Assess adnexae by moving fingers to R + L lateral fonices in turn, note any masses and adnexal tenderness
Complete the examination
Cover the patient and invite her to re-dress and advise when ready
Thank the patient, explain that you will come back to discuss any findings
Dispose of gloves in clinical waste and clean your hands
