Pelvic Exam Pelvic Examination reveals information on the health of both internal and external reproductive organs.

A pelvic exam may be performed as part of a regular checkup (or wellness visit) or can be done to investigate abnormal symptoms such as abnormal bleeding, unusual vaginal discharge, or pain. Pelvic exams are also done during pregnancy check-ups. Pelvic exams are also necessary for cervical cancer screenings, in which a sample of cells from the uterine opening (cervix) are taken for microscopic examination (known as the Pap smear or Pap test). Procedure
1. Gather necessary materials (speculum, spatula, clean gloves, lubricant, glass slide, test tube, cotton tipped applicators) 2. Perform hand hygiene 3. Explain the procedure 4. Ask client to void 5. Provide privacy 6. Place client in lithotomy position with a pillow under her head and make sure her buttocks extend slightly beyond the end of the examining table. Rationale/Assessment Reduce time consumed in procedure

Prevent transfer of microorganisms Reduce anxiety To reduce bladder size To make patient comfortable To have complete visualization of the vagina.

Separate the labia - Inspect the labia minora, clitoris, urethral meatus, and vaginal opening Internal Examination Insert Speculum - Lubricate speculum with warm water Enlarge vaginal opening by pressing on the posterior margin of the vagina using index and middle finger

Make note of any inflammation, ulcerations, discharge, swelling, or nodules.

Using cold water might contract the womans vaginal muscles Greatly increases ease of insertion of speculum

Insert speculum at downward sloping angle Slide speculum along posterior wall of the vagina - Rotate speculum to horizontal - Tighten screw Inspection of cervix - Inspect cervix and the os

Note the color of the cervix, its position, the characteristics of its surface, any ulcerations, nodules, masses, bleeding, or discharge.

Pap Smear - Using a scrape, align the scrape with os and scrape in a full circle. - Smear the slides with cells from the instruements Vaginal Inspection - Withdraw the speculum slowly - As the speculum clears the cervix, release the thumb screw and maintain open position using thumb - Close the speculum as you remove it from the vaginal opening Bimanual Exam - Lubricate index and middle fingers of one gloved hand. From standing position insert them into the vagina. - Thumb should be abducted and ring/little fingers should be flexed into the palm - Note any nodularity or tenderness in vaginal wall, including regions of urethra and bladder anteriorly - Palpate the cervix note position, shape, consistency, regularity, mobility, and tenderness. Palpating the uterus - Place other hand on abdomen midway between umbilicus and symphysis pubis. - Elevate the cervix and uterus with pelvic hand, and press abdominal hand in and down. - Place pelvic hand in anterior fornix for feeling the anterior surface and the abdominal hand will feel the posterior surface. - An obese or poorly relaxed abdominal wall may prevent palpation Palpating the uterus - Place abdominal hand on RLQ and pelvic hand in RL fornix - Press abdominal hand in and down trying to palpate any adnexal masses - Normal ovaries are somewhat tender - Usually palpable in slender relaxed women. Recto-Vaginal Examination - Slowly introduce your index finger into the vagina, and middle finger into the rectum - Ask the patient to strain down as you do

During withdrawal, note the color, inflammation, discharge, ulcers or masses.

- Note any nodularity or tenderness in vaginal wall, including regions of urethra and bladder anteriorly Palpate the cervix note position, shape, consistency, regularity, mobility, and tenderness.

this, so that anal sphincter will relax. Repeat methods used in bimanual exam. Most useful in a retro-displaced uterus.