Examination of the Female Genitalia

11/15/2011

Clinical Skills Resource Centre, University of Liverpool, UK

General

The examination should take place in a well lit environment, a wall or floor
mounted direct light source will be required
The room should be warm and the couch should have a sheet for lying on
The examination should take place in the presence of a chaperone
The procedure should be fully explained to the patient, who should be asked
to empty her bladder before proceeding
Only expose as much of the patient as is needed and cover the lower
abdomen to the mons pubis
The patient should be in a supine position with the hips and knees flexed
and the ankles close together
Abduction of the thighs reveals the external genitalia

11/15/2011

Clinical Skills Resource Centre, University of Liverpool, UK

Requirements

Couch, with sheet and covering blanket

Alcohol hand wash solution or access to sink
Gloves
Light source
Tissues
Clinical waste bin
Water based lubricant (small amount should be put on a
piece of gauze or tissue to prevent contaminating lubricant
tube once examination begins).

11/15/2011

Clinical Skills Resource Centre, University of Liverpool, UK

Inspection

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Mons pubis,pubic hair

distribution and labia majora
Gently separate the labia
minora
Inspect the clitoris, urethra
and vaginal orifice
Ask the patient to strain down
and observe for any bulging or
prolapse
Ask the patient to cough and
observe for any leakage of
urine

Clinical Skills Resource Centre, University of Liverpool, UK

Internal examination

Nulliparous
cervix

Multiparous
cervix

Cervix

Fornices
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Gently introduce the lubricated

right index finger, followed by
the middle finger
Pass downwards and
backwards in line with the
vagina
Cervix will be felt as a semihard dome with a dimple in the
middle (the external os)
The normal cervix is mobile
and movement does not cause
pain.
Assess the fornices
surrounding the cervix

Clinical Skills Resource Centre, University of Liverpool, UK

Bi-manual examination 1

Use lateral surface of

the index finger
abdominal hand to
detect the fundus of
uterus

Apply upward pressure on the

cervix and uterus by pressing in the
posterior fornix
Fingers of abdominal hand are
applied flat to abdominal wall below
umbilicus and gradually moved
towards pubic bone
Estimate distance between both
examination hands to estimate
uterine size

11/15/2011

or compare size and shape to a piece

of fruit, for example a pear.

Clinical Skills Resource Centre, University of Liverpool, UK

Bi-manual examination 2

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A normal non pregnant uterus

may be palpable just above
the pubic symphysis during
bimanual examination.
To palpate this you may have
to place your finger tips
above the pubis and gently
push down
The uterus should be
assessed for size, shape,
mobility and consistency as
well as for any masses or
irregularities

Clinical Skills Resource Centre, University of Liverpool, UK

Adnexae

Adnexae of uterus = fallopian tubes and

ovaries

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Ovaries are not always palpable in patients

unless enlarged or patient is thin
Ovaries are firm, ovoid in shape (like an olive)
and approximately 2-3cms in length.
Fallopian tubes are not palpable in health

Clinical Skills Resource Centre, University of Liverpool, UK

Palpating the adnexae 1

Place the fingers of your abdominal hand over the

iliac fossa whilst readjusting the vaginal fingers into
the corresponding lateral fornix
Position the finger pulps to face the abdominal
fingers
Gently but firmly appose the fingers of either hand
by pressing the abdominal hand inward and
downward, and the vaginal fingers upward and
laterally
Feel for adnexal structures as the interposed
tissues slip between your fingers.
Repeat the examination on the other side

11/15/2011

Clinical Skills Resource Centre, University of Liverpool, UK

Palpating the adnexae 2

The movement should

be relatively painless,
although palpation of
the ovaries might elicit
some tenderness,
If adnexal structures
are felt describe:

11/15/2011

Size, shape, position,

consistency, mobility
and tenderness
Clinical Skills Resource Centre, University of Liverpool, UK

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Completing the examination

Rotate your examining hand back to the midline before

removing your fingers gently from the vagina
Inspect your fingers for signs of blood or mucus etc.
Offer the patient tissues to wipe any excess lubricant etc.
away. (If patient unable to, ensure you explain what you are
doing before doing this for the patient)
Remove gloves from at least one hand before covering the
patient up (to avoid contaminating bedding or clothing).
Dispose of your gloves in clinical waste
Tell patient your findings and offer reassurance /
management plan.

11/15/2011

Clinical Skills Resource Centre, University of Liverpool, UK

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Summarising your findings

On examination External genitalia appeared normal .(swollen excoriated

rashes discharge etc)
Report if any evidence of stress incontinence or prolapse
Vagina felt - (normal rugae warm and moist).
Cervix felt - position, size, central, shape consistency,
surface, smooth, external oss, tenderness, mobility.
Anterior posterior and lateral fornices felt
Uterus (size, shape, position, height above symphisis pubis if
palpable)
Left and Right adnexae ovaries (or other mass /swelling)
palpated (size, shape, position, mobility, surface, consistency,
tenderness etc)
On removal presence absence of discharge blood or pus

11/15/2011

Clinical Skills Resource Centre, University of Liverpool, UK

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Recording your findings

Dont forget when recording your findings Use a

black pen

Patient identifier, date (and time), signature and name

When documenting the size, position and shape of

a swelling, a diagram may often be useful.
During some examinations you can still note and
record: size, position, shape, consistency, surface and
mobility. This must be done if a swelling is detected

11/15/2011

Clinical Skills Resource Centre, University of Liverpool, UK

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