Pelvic bimanual examination

Question 1

What must be done before commencing a bimanual pelvic examination?

Answer 1

Inform the patient that a chaperone will be present during the examination and ask the patient if they are ok with this

Document all of this

Question 2

How should the patient be exposed for a bimanual pelvic examination?

Answer 2

Give the patient a modesty sheet

Ask them to remove their underclothes in private and to let me know when they are ready

Question 3

How should the patient be positioned for a bimanual pelvic examination?

Answer 3

Lying on their back

Knees bent

Legs apart

Question 4

What should be done after the patient is in the correct position and has exposed the correct area?

Answer 4

Put on sterile gloves

Question 5

What should be done once sterile gloves have been put on?

Answer 5

Ask patient to remove modesty sheet

Question 6

What is the 1st step in a bimanual pelvic examination once the patient has removed the modesty sheet?

Answer 6

Inspect the pelvic area

Question 7

What should be noted on inspection during a bimanual pelvic examination?

Answer 7

Hair distribution

Skin abnormalities

Discharge

Swelling

Prolapse

Question 8

What should be performed after inspection?

Answer 8

Palpation

Question 9

How is bimanual pelvic palpation performed?

Answer 9

Check if any tenderness

Lubricate index and middle finger

Gently insert into vagina, feel for cervix

Feel in posterior fornix and lift uterus anteriorly

Place other hand on lower abdomen and press gently as if finger tips from both hands could meet - note the size and mobility of uterus

Move fingers to R+L lateral fornices feeling for any adnexae

Note any masses

Question 10

What should you tell the patient once you have finished your examination?

Answer 10

Cover the patient with the modesty sheet and invite them to re-dress

Once dressed, thank the patient and explain you will come back to discuss any findings