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11/13/24, 7\:11 PM Guide | Vaginal examination (PV)

Vaginal examination (PV)

Table of contents
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Gather equipment

Gather the appropriate equipment\:
Gloves
Lubricant
Paper towels
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Gather equipment

Introduction

Wash your hands and don PPE if appropriate.
Introduce yourself to the patient including your name and role.
Con
Explain what the examination will involve using patient-friendly language\:
" T o d a y , I n e e d t o c a r r y o u t a v a g i n a l e x a m i n a t i o n .
T h i s w i l l i n v o l v e m e u s i n g o n e h a n d t o f e e l y o u r t u m m y a n d t h e o t h e r h a n d t o p l a c e t w o
m e t o a s s e s s t h e v a g i n a , w o m b a n d o v a r i e s . I t s h o u l d n’ t b e p a i n f u l , b u t i t w i l l f e e l a l i t t l e u n c o m f o r t a b l e . Y o u c a n a s k m e t o s t o p
a t a n y p o i n t .
"
Explain the need for a chaperone\:
a s a c h a p e r o n e , w o u l d t h a t b e o k ?”
“ O n e o f t h e f e m a l e w a r d s t a
Gain consent to proceed with the examination\:
h a p p y f o r m e t o c a r r y o u t t h e e x a m i n a t i o n ?"
" D o y o u u n d e r s t a n d e v e r y t h i n g I' v e s a i d ? D o y o u h a v e a n y q u e s t i o n s ? A r e y o u
Ask the patient if they have any pain or if they think they may be pregnant before proceeding with the clinical examination.
Provide the patient with the opportunity to pass urine before the examination.
Explain to the patient that they'll need to remove their underwear and lie on the clinical examination couch, covering
themselves with the sheet provided.
Provide the patient with privacy to undress and check whether it is okay to re-enter the room before doing so.

Abdominal examination

A brief abdominal examination should always be performed before moving on to a bimanual vaginal examination. This may be
less thorough than a full abdominal examination but should at least include inspection and palpation of the abdomen to
identify any pain or masses.
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Perform a brief abdominal examination

Reposition the patient

1. Re-check consent and that the patient is happy to proceed with the examination\:
g e n i t a l s . A r e y o u h a p p y f o r m e t o d o t h i s ?"
2. Position the patient in the modi
t h e b e d , a n d t h e n l e t y o u r l e g s f a l l o p e n"
.
" D r a w y o u r a n k l e s u p t o w a r d s y o u r b u t t o c k s , " I' m g o i n g t o m o v e o n a n d e x a m i n e y o u r
k e e p y o u r f e e t
Position the patient in the modi

Vulval examination

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A vulval examination should be performed before moving on to the bimanual examination. This is to look for any vulval
pathology or lymphadenopathy.
1. Don a pair of non-sterile gloves and an apron
2. Expose the patient's external genitalia and ensure there is adequate lighting
Don apron and gloves

Palpate the inguinal lymph nodes

1. Palpate the inguinal lymph nodes to identify lymphadenopathy, which may be associated with\:
Acute infections (e.g. chlamydia, herpes)
Malignancy (e.g. vulval cancer)
Palpate inguinal lymph nodes
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Inspect the vulva

1. Inspect the vulva for abnormalities\:
Ulcers\: typically associated with genital herpes
Abnormal vaginal discharge\: causes include candidiasis, bacterial vaginosis, chlamydia and gonorrhoea
Scarring\: may relate to previous surgery (e.g. episiotomy) or lichen sclerosus (scarring with associated abnormal
architecture)
Vulvovaginal atrophy\: most commonly occurs in postmenopausal women
White lesions (leukoplakia)\: may be patchy or in a
lichen sclerosus
Other lesions\: causes include folliculitis, molluscum, genital warts and vulval malignancy
Masses\: causes include Bartholin’s cyst and vulval malignancy
Varicosities\: varicose veins secondary to chronic venous disease or obstruction in the pelvis (e.g. pelvic malignancy)
Female genital mutilation\: total or partial removal of the clitoris and/or labia and/or narrowing of the vaginal introitus
2. Inspect for evidence of vaginal prolapse (a bulge visible protruding from the vagina). Asking the patient to cough as you
inspect can exacerbate the lump and help con
Inspect the vulva and perineum
Female genital mutilation
The WHO de
f e m a l e g e n i t a l i a , o r o t h e r i n j u r y t o t h e f e m a l e ge n i t a l o r g a n s f o r n o n-m e d i c a l r e a s o n s"
5
.
Over 200 million girls and women worldwide have undergone FGM. 5
Women attending maternity, family planning,
gynaecology, and urology clinics (among others) should be asked routinely about the practice of FGM. 6
In the UK,
healthcare professionals must report cases of FGM in girls under the age of 18 to the police.
7
Bartholin's cyst
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Bartholin's glands are responsible for producing secretions which maintain vaginal moisture and are typically located at
4 and 8 o'clock in relation to the vaginal introitus. These glands can become blocked and/or infected, resulting in cyst
formation. Typical
Lichen sclerosus
Lichen sclerosus is a chronic in
presents with pruritis and clinical examination typically reveals white thickened patches. Destructive scarring and
adhesions develop causing distortion of the normal vaginal architecture (shrinking of the labia, narrowing of the introitus,
obscuration of the clitoris).
Abnormal vaginal discharge
There are several causes of abnormal vaginal discharge including\:
Bacterial vaginosis\: typical
Candidiasis\: typical
Chlamydia and gonorrhoea (symptomatic)\: typical
Trichomoniasis\: typical
in

Vaginal examination

Warn the patient you are going to examine the vagina by inserting two
If the patient consents to continue the examination\:
1. Lubricate the gloved index and middle
2. Carefully separate the labia using the thumb and index
3. With your palm facing laterally, gently insert the gloved index and middle
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Lubricate gloved index and middle

Vaginal walls

Palpate the walls of the vagina for any irregularities or masses.
Palpate the vaginal walls

Vaginal fornices

The fornices are the superior portions of the vagina, extending into the recesses created by the vaginal portion of the cervix.
Gently palpate the fornices for any masses.
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Palpate the left fornix

Cervix

Examine the surface of the cervix to assess\:
Position (e.g. anterior or posterior)
Consistency (e.g. irregular, smooth)
Examine for cervical motion tenderness\:
1. Place your non-dominant hand on the abdomen in the suprapubic region
2. Using your two
Pain on palpation of the cervix may suggest pelvic in.
Palpate the cervix
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Uterus

Bimanually palpate the uterus\:
1. Place your non-dominant hand on the abdomen in the suprapubic region
2. Push upwards with the internal
able to feel the uterus between your hands.
You should then assess the various characteristics of the uterus\:
Position\: the uterus may be anteverted or retroverted
Size\: the uterus should be approximately orange-sized
Shape\: may be distorted by masses such as large
Surface characteristics\: note if the uterus feels smooth or nodular
Tenderness\: may suggest inpelvic in)
Bimanually palpate the uterus
Uterine position
The position of the uterus can be described as\:
Anteverted\: the uterus is orientated anteriorly towards the bladder. This is the most common position of the uterus.
Retroverted\: the uterus is orientated posteriorly towards the spine. This is a less common uterine position.

Ovaries and uterine tubes

The term adnexa refers to the area that includes the ovaries and fallopian tubes.
Bimanually palpate the adnexa\:
1. Position your internal
2. Position your external hand onto the left iliac fossa
3. Perform deep palpation of the left iliac fossa whilst moving your internal
4. Feel for any palpable masses, noting their size and shape (e.g. ovarian cyst, ovarian tumour,
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5. Repeat the adnexal assessment on the right
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Finish examination

1. Withdraw your
2. Cover the patient with the sheet, explain that the examination is complete and provide the patient with privacy so they can
get dressed. Provide paper towels for the patient to clean themselves.
3. Dispose of the used equipment into a clinical waste bin.
Palpate the left adnexa

Finish examination

1. Withdraw your
2. Cover the patient with the sheet, explain that the examination is complete and provide the patient with privacy so they can
get dressed. Provide paper towels for the patient to clean themselves.
3. Dispose of the used equipment into a clinical waste bin.
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Source\: geekymedics.com
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