Gynae Examination

Question 1

WIPER QQ

Answer 1

W - disinfect hands before and after
I - my name is An, I’m a 4th year medical student
PER - I’ll be doing an external and internal examination of your vagina. This will require you to be undressed from the waist down, however I will provide a sheet to maintain your dignity.
As these are intimate examinations, we will have a female chaperone in the room, I will lock the door so you are not disturbed.

Would this be ok?

This examination may be uncomfortable if you have a full bladder, would you like to go to the bathroom before we begin

Speculum - I will be using a speculum so I can examine the vagina and cervix. So this examination is more comfortable, I will lubricate the speculum.

Bimanual - This will involve me using 1 hand to feel your tummy, and use my other hand to place 2 fingers into your vagina. This will allow me to assess the vagina, womb and ovaries

I will talk through what I am doing throughout the examination

It shouldn’t be painful, but it will feel a little uncomfortable. You can ask me to stop at any point.

Do you have any questions?
Do you have any pain anywhere?

Answer 2

Patient
-well/unwell
-any pain

Surroundings

Question 3

Abdo
-inspection
-palpation
-auscultation
-consider

Answer 3

Inspection
-mass
-symmetry
-movement with respiration
-linea nigra
-striae gravidarum
-surgical scars

Palpation
-abdo/pelvic mass - size, location, mobility, texture
-assess liver, spleen, kidney

Auscultate
-bowel sounds

Consider urinedip, BP

Question 4

Vaginal examination
-inspection

Answer 4

Warts
Rashes
Lumps
Ulcers
Vesicles
Excoriation

Question 5

Speculum examination
-steps
-cervical smear

Answer 5

TALK THROUGHOUT YOUR EXAMINATION

Lubricate blades
Hold speculum with dominant hand
Separate labia with non dominant hand
Insert blades laterally and rotate as you enter slowly
Adjust so you can see the cervix

Inspect
With brush, rotate 360deg 5x and dab brush into liquid in pot for 10s
Ensure that cells are present in the pot

Unlock speculum, remove slowly so vaginal walls are not trapped between the blades

Question 6

Bimanual examination

Answer 6

Use gloved ND thumb and 1st finger to part labia

Ask patient to cough - incontinence
Ask patient to strain - prolapse

Insert lubricated gloved index and middle fingers of DH
Rotate fingers anteriorly behind cervix

Cervical excitation
Texture of cervix and rectovaginal space

Use your other hand to palpate down, try to bounce the uterus up -
If palpable => anteverted anteflexed
if not palpable => retroverted, retroflexed

Move ND hand down laterally to examine adnexa
Examine for masses
-size
-location
-texture
-mobility
-tenderness

Withdraw fingers
Offer tissues

Question 7

Further actions

Answer 7

Hx
Vital signs - BP

Abdominal examination

Pregnancy test
Urine dip

TVUS