LECTURE 11 (Bimanual examination)

Question 1

What is a bimanual vaginal examination?

Answer 1

A medical procedure used to assess the reproductive organs of a female patient involving the use of both hands to examine structures within the pelvis, including the uterus and ovaries

[usually performed as part of a routine gynaecological examination or when a patient presents with specific symptoms/concerns]

Question 2

What are different clinical scenarios in which bimanual vaginal examination in performed?

Answer 2

• Unexplained pelvic pain
• Irregular vaginal bleeding
• Abnormal vaginal discharge
• As part of the assessment of a pelvic mass

Question 3

What does a healthy vagina look like?

Answer 3

• Healthy vaginal mucosa is reddish pink
  [during pregnancy may become dusky/cyanotic]
• Cervical diameter should be 2-3cm with a length of 2-4cm
• Cervix is normally pink

Question 4

What must be ensured before the bimanual examination?

Answer 4

• Patient should be in lithotomy position
• Patient should pass urine before examination
• Privacy

Question 5

What are the abnormalities to look out for in the vulva?

Answer 5

[vulva is examined visually for lesions then by palpation]

ABNORMALITIES:
- Ulcers (genital herpes)
- Abnormal vaginal discharge
- Scarring (previous surgery)
- Vaginal atrophy (common in post-menopausal women)
- Masses (Bartholin’s cyst/Vulval malignancy)
- Varicosities
- Female genital mutilation (total or partial removal of the clitoris/labia)
- Vaginal prolapse (bulge visible protruding from the vagina) -> ask patient to cough to exacerbate lump

Question 6

What must you inspect in vaginal walls and cervix?

Answer 6

Vaginal walls = palpate for any irregularities or masses

Cervix = position, consistency (irregular, smooth), cervical motion tenderness (severe pain on palpation of cervix may suggest pelvic inflammatory disease or ectopic pregnancy)

Question 7

What should you assess about the uterus?

Answer 7

• Size
• Shape
• Position
• Surface characteristics
• Tenderness

Question 8

What is the Adnexa?

Answer 8

The area that includes the ovaries and Fallopian tubes

Question 9

Why do doctors examine using bimanual examination alongside a rectal examination?

Answer 9

• To assess firmness or nodules between the uterus and rectum
• To find tumours
• To look for uterosacral ligamentous endometriosis