Gynaecological Examination (Including Cervical Smear)

Examination

Inspection and palpation of the abdomen should be done in patients with the possibility of a mass.  The patient should be lying flat and superficial and deep palpation of all 9 regions of the abdomen should be done.  Look for any swellings, ascites, tenderness etc.

Gynaecological Examination- you may want to do a smear and bimanual (note if hymen is still intact or if suspected placenta praevia- do NOT undergo any internal vaginal examination)

Intro

  • Wash hands, introduce, check name and dob
  • Explain what you will be doing and explain why
  • Offer a chaperone
  • Provide privacy for undressing and assistance if needed
  • Wear gloves
  • Position the woman with her heels together and knees apart or whatever is comfortable for the patient

Inspection

  • Look at the external genitalia for any deformity/ scars/ cysts/ redness/ inflammation/ discharge etc
  • Ask the patient to cough, and look for any evidence of prolapse

Cervical smear

NB Should always be done before a bimanual examination

  • Prepare and insert the bivalve speculum
    • Apply some lubricating gel on the speculum blades beforehand
      • try not to use much on the tip of the blades as this can ruin any sampling
    • Using your other hand, separate the labia and then insert the speculum so it is parallel with the labia (i.e. the handle facing the woman’s leg).
      • Once it is past the introitus and in (the normal vaginal passage is around 8cm), rotate the speculum so the handle is facing up
      • Open the blades.  If the cervix cannot be visualised, try closing the blades, retracting them slightly and trying again.
      • Inspect the cervix’s shape, any bleeding or discharge, abnormality etc
      • Also inspect the walls of the vagina
    • Using the smear brush, collect the sample by rotating the brush 5 times clockwise in the cervical os.
    • Take care to remove the brush.  The tissue can then be transferred to the container by pushing down 10 times and by rotating the brush (anticlockwise) to remove any more tissue.  Make sure all the sample has been transferred before disposing of the brush.
    • Close the container properly by lining up the black lines of the lid and pot.
  • After
    • Close the blades and remove the speculum as it was inserted (i.e. it should exit parallel to the labia)
    • Provide a tissue for the patient and privacy for dressing
    • Inform the patient of what will happen concerning results and answer any questions they may have.

Bimanual examination

  • Again, use lubricant on your gloved fingers
  • Separate the labia with the non-dominant hand and with the other hand, insert 2 fingers (start with one to check if painful)
  • Feel the cervix, commenting on shape and position
    • Check for cervical excitation (tenderness on movement)
  • With your examining hand in the anterior fornix and the other hand on the abdomen, try and ballot the uterus between hands (this will work only for anteverted uterus’).  Comment on the size, motility etc of the uterus
  • Feel in the lateral fornices and, similarly, see if it is possible to feel any adnexal masses (not normal)
  • Cover the patient and provide a tissue and privacy for redressing.

Always perform an abdominal examination as part of the full gynaecological examination

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