LEARNING GUIDE FOR GYNECOLOGIC EXAM

GETTING READY

1. Explain why the examination is being done and describe the steps in the examination
2. Inform the patient before you do each steps in the examination
3. Ask the patient to void and wash her genital area
4. Check the necessary materials ( gloves, lubricant, speculum, light source,
Cotton pledget, glass slide, acetic acid , etc

BREAST EXAMINATION

1. Tell the woman you are going to examine her breast

2. Inform the patient before you do each steps in the examination
3. Ask the patient to undress from her waist up
4. help her sit onto the examining table with the arms on her sides
5. Wash your hands and dry them thoroughly
6. Look at the breast and note any differences in shape, size, nipple or skin puckering
Dimpling, swelling

7. Look at the nipples and note size, shape and direction

8. Ask the woman to raise her arm over her head and look at the breast. Note any differences
9. Ask the woman to press her hands on her hips and look again for any differences
10. Ask her to lean forward to see if breast hang evenly
11. Have her lie down on the examining table
12. Place a pillow on her left shoulder and place her left arm over her head
13. Look at the left breast and note any difference from the right breast
14. Using the pads of your three middle fingers, palpate the entire breast, starting around the nipple to the
outermost using spiral technique. Note for masses and tenderness.
15. Palpate the tail of the breast by pressing along the pectoralis muscle to the axilla. Note for masses and
tenderness
16. Use thumb and index finger to gently squeeze the nipple to note any discharges
17. Repeat the steps on the right breast
18. After completing the examination, have the woman cover her upper body

LOWER ABDOMINAL AND GROIN EXAMINATION

1. Ask the woman to lie down with her arms on the sides
2. Inform the patient before you do each steps in the examination
3. Expose entire abdomen
4. Note swelling, bulges, shape and location of umbilicus
5. Inspect for abnormal discoloration, scars, stretch marks, rashes, lesions
6. Using light pressure with pads of fingers, palpate all areas.
Identify any masses, tenderness, resistance

7. Using deeper pressure determine size, shape, consistency, tenderness, mobility of any
Masses and areas of tenderness

8. If tender areas noted, check for rebound tenderness

9. If open sores are present put new gloves before examining groin.
Palpate both groin areas for bumps, buboes, swelling

EXTERNAL GENITALIA EXAMINATION

1. Ask the woman to place heels on stirrups. Drape
2. Wash hands, dry
3. Turn on light to direct to genital area
4. Put new gloves
5. Inform the patient before you do each steps in the examination
6. Touch the inside of thigh before touching the genitalia
7. Inspect external labia, clitoris, perineum
8. Separating the labia majora with two fingers, check the labia minora, urethral opening and vaginal opening
9. Palpate the labia minora and note for abnormalities
10. Check the Skene’s glands for discharges and tenderness. With the palm facing upward, insert the index
finger into the vagina and gently push upwards against the urethra and milk the gland on each side and then
directly on the urethra. If discharge is present, take a smear for gram staining
11. Check the Bartholin’s gland. Insert index finger into vagina at lower edge of opening and palpate at each
base of the labia majora. Using your finger and thumb, palpate each side for any swelling or tenderness. If
discharge is present, take a smear for gram staining
12. Ask the patient to bear down while you hold the labia open. Check for any bulging of the anterior and
posterior vaginal walls
13. Look at the perineum, check for scarring, lesions,
SPECULUM EXAM

1. Select a bivalve speculum and show it to the patient. Inform the patient of each move you do in advance.
Explain what u are going to do
2. Moisten the speculum with warm water or put a lubricant
3. Open the labia with one hand while your other hand inserts the speculum at 45 degrees angle into the
vaginal opening directed downwards. Once midway position insert the speculum fully. Open the speculum. The
cervix now comes into view. Lock the speculum
4. Inspect the cervix and note the color, smoothness, lesions, position, discharge, bleeding. If there is
mucopus, obtain specimen for gram stain
5. Identify the cervical os, squamocolumnar junction and Transformation zone
6. Look at the vaginal walls and note any ulcers, inflammation and other abnormalities
7. Unlock the speculum. Remove the speculum by closing it, take note not to bite the cervix, and turning it
sideways .
8. Place the speculum in 0.5% chlorine solution for decontamination

BIMANUAL PELVIC EXAM

1. Immerse gloved hand (abdominal hand) in 0.5% chlorine solution, then remove them by turning them inside
out, place it in a leakproof container or infectious yellow plastic bag. Put on lubricant or wet with clean water or
vaginal secretions on the fingers (pelvic hand) that will be inserted into vagina
2. Inform the patient what you are going to do
3. Using the pelvic hand separate the labia with the thumb and small finger, insert the index and middle finger
into the vaginal opening while exerting gentle pressure downwards
4. Turn your palm upward and follow the anterior vaginal mucosa until you feel the cervix
5. Feel the length , size, position, consistency and shape of the cervix
6. Move the cervix gently from side to side and note if pain is felt by patient
7. With the palm up, place your fingers in the space below the cervix to feel for the body of the uterus
8. Place your other hand (abdominal hand) flat on the abdomen, midway between the umbilicus and symphysis
pubis
9. Slowly slide your abdominal hand toward the symphysis pubis, pressing downward with the pads of your
finger. At the same time, push inward and upward with the fingers of the pelvic hand, trying to trap the uterus
between your hands.
10. Palpate the uterus and check for size, shape, location, consistency, mobility, tenderness
11. Locate the ovary by placing the fingers of the pelvic hand inside the vagina with the tips in the lateral fornix.
Move your abdominal hand to the same side and lateral to the uterus. Press down with the abdominal hand
and reach up with the fingers of the pelvic hand. Gently bring the fingers of both hands together and move
them to symphysis pubis
12. Repeat this procedure on the other ovary
13. Determine size, consistency , mobitity, tenderness and any masses in the adnexae
RECTOVAGINAL EXAM

1. Inform the patient what you are going to do

2. If you need to change gloves, immerse gloved hand in 0.5% chlorine solution, then remove them by turning
them inside out, place it in a leakproof container or infectious yellow plastic bag. Put on a new gloves in the
examining hand. Put lubricant.
3. Slowly insert the middle finger into the rectum and the index finger into the vagina. Ask the patient to exhale
to relax
4. Press down firmly and deeply with the abdominal hand above the pubic bone while the vaginal and rectal
fingers of the other hand are pushing anteriorly on the cervix
5. Check for tenderness and masses between uterus and rectum
6. Check if the rectovaginal septum is intact, if there is presence of masses
7. Check if there is masses in rectal wall
8. After completing examination, remove both fingers slowly
9. Immerse gloved hand in 0.5% chlorine solution, then remove them by turning them inside out, place it in a
leakproof container or infectious yellow plastic bag

POST EXAMINATION

1. Wash your hands thoroughly and dry them

2. Help the woman sit up and get dressed
3. After the woman is dressed up, sit down with her and discuss your findings and give instructions for further
laboratory test if needed and when to follow up. If examination is normal, tell her it is normal