2. • Pelvic and abdominal examination confers pathology from Gynaecology history.
• Before start doing each procedure we need to explain everything beforehand.
• Obtain verbal consent from the patient
• Examination has to done in private setting,for privacy of the patient.
3. ABDOMINAL EXAMINATION
Before all these we ask patient to empty the bladder.
• Inspection: Look for contour of abdomen and appearance of the
abdomen.Striae,scars, hyperpigmentation noted.
• Auscultation: It aids assessment of intestinal peristalsis (bowel sounds).It used to
detect abdominal bruits.
• Percussion:It helps to determine size of abdominal structures underneath it .Look
for organs like liver,spleen .It also used to assess ascites collection
• Palpation: It assess organ enlargement,massess, tenderness.
5. EXTERNAL EXAMINATION
• Inspect mons,look for pattern of hair distribution.Separate labia majora look for
any anatomical abnormalities,visible vaginal discharge –color,odor, character
• Inspect skin of external genitalia: inflammation, swelling, atrophy,
ulceration,warts,scars, pigmentation,other skin lesions.
• Inspect clitoris: look for size and lesions
• External urethral meatus: look for inflammation, discharge and any masses
• Watch for opening of Bartholin duct,it appears usually when it was inflamed.
• Look for character of hymen.
6. • Look for character of hymen.
• Ask patient to strain or cough to elicit stress incontinence,genital prolapsed
structures like Anterior vaginal wall, uterus, Posterior vaginal wall.
• Palpation: palpate Bartholin gland area, which is not palpable check for
tenderness,cyst or abscess.Press urethra from above look for any discharge.
7. SPECULUM EXAMINATION
• Separate labia, lubricate index and middle finger introduce into vagina with palm
facing laterally,then hand rotated 90° that palm faces upwards.
• Thumb should be abducted,ring and little finger flexed to palm
• Feel vaginal wall for tenderness and nodularity
• Cervix os : look for position, consistency,motion/mobility, tenderness and any
pathology.
• Adnexae: place one hand on abdomen and other with pushing cervix and
uterus.Try to grab uterus inbetween.Check for size ,shape, position, consistency,
mobility, tenderness.
8. RECTAL EXAMINATION
• Rectal examination should be performed with lubrication.
• Slow,single digit insertion on rectal sphincter, decrease discomfort.
• Look for hemorrhoids,polyps, growth and tone of sphincter.
• Insert index finger into vagina and third into rectum.
• Recto-vaginal septum and distal portion of cul de sac- evaluate for distortion or
tenderness.To check any mass,lumps palpated.
