Bimanual vaginal examination - OSCE Guide | Geeky Medics

3/4/15, 7:50 PM

BIMANUAL VAGINAL EXAMINATION OSCE GUIDE

Bimanual vaginal examination is performed for a number of different clinical
indications, including unexplained pelvic pain, irregular vaginal bleeding, vaginal
discharge and assessment of a pelvic mass. It frequently appears in OSCEs, most often
with a mannequin, however you will still be required to demonstrate appropriate
communication skills. This guide demonstrates how to perform a bimanual vaginal
examination in your OSCE.
Introduction
Wash hands
Introduce yourself
Check patient details name / DOB
Explain the examination & gain consent (as shown below)
Explanation
Describe the examination
Assess current understanding of the examination:
Ive been asked to carry out a bimanual examination. Do you understand what the
examination involves?
Provide a detailed explanation of the examination:
What the examination will involve is me using one hand to feel your tummy and the
other hand to place two fingers into your vagina. This will allow me to assess the
vagina, womb and ovaries. It shouldnt be painful, but it will feel a little
uncomfortable. Let me know at any point if you would like me to stop
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.
Explain the need for a chaperone:
For this examination, one of the female nursing staff will be present, acting as a
chaperone
Gain verbal consent:
Does everything Ive said make sense? Do you have any questions? Are you happy for
me to perform the examination?
.
Ask if the patient would like to go to the toilet to empty their bladder before
the examination
Position
The patient should be laid on a bed with their trousers/underwear removed
& their abdomen exposed (modesty cloth should be provided):
I need you to go behind the curtain and remove your trousers and underwear, then
get onto the bed. You can cover yourself with the sheet provided. Just let me know
when youre ready
.
Position the patient in the modified lithotomy position:
Bring your heels towards your bottom and then let your knees fall to the sides
Gather equipment
Gloves

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Lubricant
Inspection
Put on gloves
Inspect the vulva for
Varicosities varicose veins
Ulcers e.g. genital herpes
Abnormal discharge & bleeding
Abnormal hair distribution
Scars previous surgery e.g. episiotomy
Atrophy postmenopausal
Lumps e.g. Bartholins cyst
Internal examination
Warn the patient you are going to examine the vagina & ask if theyre still
comfortable
Entering the vagina
1. Lubricate gloved fingers
2. Carefully separate the labia using the thumb and index finger of your left hand
3. Gently insert the gloved index & middle finger of your right hand into the vagina
4. Enter the vagina with palm facing laterally & then rotate 90 degrees so that it faces
upwards
.
Vagina, Cervix & Fornices

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Assess the vagina

Palpate the walls of the vagina for any irregularities and/or masses
Assess the cervix
Position
Consistency (hard/soft)
Os (open/closed)
Cervical excitation severe pain on palpation of cervix e.g. PID / ectopic
pregnancy
Assess the fornices
Gently palpate the fornices either side of cervix for any masses
.
Uterus
Palpate the uterus
1. Place your left hand 4cm above symphysis pubis
2. Place your right hand in posterior fornix
3. Push up with internal right hand on the cervix
4. Push down on the abdomen with your left hand towards the internal fingers of your
right hand
5. You should now feel the uterus between your hands. Assess the various characteristics
of the uterus shown below.
.
Assess the uterus

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Size (small orange sized normally)

Shape (fibroids)
Position (anteverted / retroverted)
Surface characteristics (e.g. smooth / nodular)
Tenderness?
.
Ovaries & Uterine Tubes
Assess the adnexa
1. Place internal fingers into the left lateral fornix
2. Place external fingers onto the left iliac fossa
3. Press external hand downwards whilst internal fingers press upwards and laterally
4. Feel for any palpable masses, noting their size and shape (ovarian cyst/ovarian
tumour/fibroid)
5. Repeat adnexal assessment on the right side

To complete the examination

Withdraw your fingers observe glove for blood or discharge
Re-cover the patient - allow patient time to re-dress in private
Thank patient
Wash hands
Summarise findings:

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On examination of Mrs Smith, a 29 year old female, there were no abnormalities

noted on inspection of the vagina. Internal examination findings were unremarkable,
with no tenderness or masses noted. The uterus was anteverted, normal size and
normal shape. No masses were noted in the adnexa. These findings are consistent with
a normal vaginal examination.
.
Say you would
Perform abdominal ultrasound scanning if indicated
Obtain a vaginal swab microbiological culture / virology
Perform a full abdominal examination
.

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