Vaginal Examinations

Question 1

Give some psychological and emotional issues surrounding VE

Answer 1

• Can be painful, distressing, embarrassing, invasive
• Issues of sexual intimacy, vulnerability, sexual abuse, physical abuse, rape
• Give women opportunity to disclose issues when fully clothed
• Examination should not proceed if it causes distress

Question 2

What is vaginismus?

Answer 2

• Fear of penetration
• Relates to past experiences or of unknown origin
• May need referral to psychosexual counselling

Question 3

Give some consent issues surrounding VE

Answer 3

• Should be verbal and informed
• Without coercion
• Should be gained for each separate procedure
• Without consent, a VE is assault
• Consent can be withdrawn at any stage
• Must be obtained prior to procedures under anaesthetic

Question 4

What is coercion?

Answer 4

Persuasion

Question 5

Who should special considerations be made for when gaining consent?

Answer 5

• <16s
• Learning difficulties
• Mental illness
• Cultural, ethnic and religious diversities

Question 6

Give some reasons for a VE to be carried out

Answer 6

• To confirm onset of labour
• Determine presentation, attitude and position
• Assess progress/delay in labour
• To apply Foetal Scalp Electrode/ FBS
• Screening/ diagnostic purposes
• To assess trauma post-delivery
• Maternal request

Question 7

What are some contra-indications for VE?

Answer 7

• Vaginal bleeding
• Placenta praevia
• Preterm labour
• Preterm rupture of membranes
• Speculum
• No consent given

Question 8

What is a speculum?

Answer 8

• Holds vagina open to shine torch down so VE can be done visually
• Only for specified circumstances such as pre-labour rupture of membranes

Question 9

What should be considered prior to the VE?

Answer 9

• • Can you document a clear reason for performing a VE?
• Is there another non-invasive way to acquire info?
• Are you following policies and guidelines?

Question 10

Give some alternative approaches to a VE

Answer 10

• Listen to woman
• Watch for behaviour changes
• Look for changes in FHR
• External signs (e.g. purple line, labial gaping, anal dilation)

Question 11

How should you prepare for a VE?

Answer 11

• Establish justification
• Obtain consent
• Respect maternal wishes
• Consider woman’s comfort, dignity and privacy
• Consider analgesia
• Consider cultural, religious and ethical needs
• Palpate abdomen and auscultate FHR
• Position appropriately
• Consider allergies
• Consider ANTT
• Prepare equipment

Question 12

What equipment is required?

Answer 12

• Gloves
• Adequate lighting
• Speculum
• Swabs
• Gauze
• Water
• Sterile lubricating gel

Question 13

Describe the VE procedure

Answer 13

1. If needed, clean vulva top to bottom
2. Prepare equipment
3. Put on sterile gloves and apply gel to ‘clean hand’
4. Use ‘dirty hand to hold labia apart and assess
5. Gently insert 2 ‘clean finger’, one at a time, down and back into vagina and assess
6. Assess the cervix once identified
7. Assess the cervix if able to enter

Question 14

What should be assessed on the labia?

Answer 14

• Varicosities
• Lesions, warts, spots, cysts, scars
• PV loss, discharge/ liquor/ blood
• Redness, heat, moisture
• Oedema (swelling)

Question 15

What should be assessed in the vagina?

Answer 15

• Muscle tone of vagina and pelvic floor

- Dryness and excess heat - signs of infection

Question 16

What should be assessed for at the cervix?

Answer 16

• Position
• Consistency
• Length/ effacement
• Dilation
• Application to presenting part
• Abnormalities (e.g. oedema)

Question 17

What should be assessed inside the cervix?

Answer 17

• Presence/ absence of membranes
• Presentation
• Station of presenting part
• Position of foetus
• Flexion/ attitude of head
• Presence of caput or moulding
• Abnormalities (e.g. presence of cord/ placenta)

Question 18

What is the station of the presenting part in relation to?

Answer 18

Ischial spines

Question 19

What do anterior and posterior refer to?

Answer 19

Anterior = towards mum's head
Posterior = towards mum's feet

Question 20

What are the 8 main positions?

Answer 20

1. LOA (left occipitoanterior)
2. LOP (left occipitoposterior)
3. LOL (left occipitolateral)
4. ROA (right occipitoanterior)
5. ROP (right occipitoposterior)
6. ROL (right occipitolateral)
7. OA (occipitoanterior)
8. OP (occipitoposterior)

Question 21

What do flexed and deflexed mean?

Answer 21

Flexed = chin to chest
Deflexed = head back

Question 22

How should station be assessed?

Answer 22

• Same as engagement
• In relation to ischial spines
• Abdominal palpations

Question 23

What is the difference between assessing engagement and station?

Answer 23

Station = VE
Engagement = palpation

Question 24

What should be done post examination?

Answer 24

• Auscultate foetal HR
• Ensure comfort and hygiene
• Discuss findings
• Ensure awareness of any pv loss noted
• Record keeping
• Plan of care

Question 25

What should be documented?

Answer 25

• Abdominal palpation and FHR
• Reason for VE and consent
• External genitalia
• State of vagina
• Membranes and liquor
• Cervix position, consistency, effacement, dilation and presenting part
• Caput, moulding or abnormalities
• Foetal heart after VE
• Explanation of findings to mother and advice given
• Plan, including referral if necessary