4.  Discharge
 Swelling
 Ulcerations
 Nodules
 Masses
 Tenderness
 Pain
 Pruritis
 Pap Smear
 Menstrual Flow
 Menopause
 Para Gravida
 Prolapsed

5.  Colour
 Discharge
 Ulceration
 Bleeding
 Inversion

6.  Nodes
 Enlargement
 Tenderness
 Rash
 Inflammation.

15.  The patient must have an empty bladder.
 The patient must be appropriately gowned
and draped.
 Use non-sterile gloves on both hands.
 Properly dispose of soiled equipment and
supplies.

16.  Both male and female examiners should
be chaperoned by a female assistant.
 Always tell the patient what you are about to
do before you do it.
 The breast exam is usually done just before
routine pelvic exams.

17.  Supine position with head elevated 30 to 45
degrees.
 Assist the patient to place her heels in the
stirrups.
 Have the patient slide her hips down until she
contacts your hand at the edge of the table.
 Have the patient relax her knees outward just
beyond the angle of the stirrups.

18. Taking History:-
 Do you experience hot flushes or flashes? If
so, how bothersome are they?
 Are you experiencing menstrual irregularities?
 Do you practice contraception?

19.  Are you having any problems or changes you
attribute to menopause? What are they? Could
anything else be causing these problems or
changes?
 How do you feel about approaching
menopause?
 Are you receiving hormone therapy for
menopause?
 If you have completed menopause, have you
had any bleeding?

20. FINDINGS :-
 Hair Distribution
 Skin Of Perineum
 Labia Majora Closed Or
Gapping
 Clitoris - About 2 Cm In
Length And 0.5 Cm In
Width
 Urethral Orifice
 Vaginal Orifice
 Anus -

21. NORMAL FINDINGS:-
Cervix :-
 pink
 midline
 usually about 2 to 3 cm in
diameter
 smooth
 firm, rounded or oval
 odorless, creamy or clear
secretions

22. VAGINA
 Pink throughout;
 Clear or cloudy,
 Odorless secretions;
 About 10 to 15 cm
in length.

23.  Ovaries may or may not be palpable; firm,
slightly tender, oval, mobile; about 4 cm in
diameter
 Uterus – mobile, rounded, palpable at level of
pelvis.
 Skene's glands and Bartholin's gland - normal
findings: nontender, no discharge.

24.  Labial folds flatten
 Skin paler, shiny
 Meatus usually more posterior
 Cervix decreases in size; may appear paler
 Scanty cervical discharge
 Vagina shortens with age
 Decreased vaginal secretions
 Uterus diminishes in size; may not be palpable
 Ovaries atrophy with age

25.  Uncover the vulva by moving the center of the
drape away from you. Try to avoid creating a
"screen" with the drape pulled tight between
the patient's knees.
 Announce what you are going to do and then
touch the patient on the thigh with the back of
your hand before proceeding.
 Inspect the outer genitalia for redness,
swelling, lesions, masses, or infestations.

26.  Gently palpate the labia majora and minora.
 Inspect the labia, the folds between them, and
the clitoris.
 Note any redness, swelling, lesions, or
discharge.
 Reassure the patient, if the exam is normal so
far.

27.  Speculum Examination
 Bimanual Examination

28.  Warm and lubricate the speculum.
 Announce what you are going to do and then
touch the patient.
 Expose the introitis.
 Insert the speculum at a 45 degree angle
pointing slightly downward.

29.  Once past the introitis, rotate the speculum to
a horizontal position and continue insertion
until the handle is almost flush with the
perineum.
 Open the "bills" of the speculum 2 or 3 cm
using the thumb lever.
 Secure the speculum by turning the thumb nut
or clicking the ratchet mechanism.
 Do not move the speculum while it is locked
open.

30.  Observe the cervix and vaginal walls for
lesions or discharge.
 Obtain specimens for culture and cytology as
indicated.
 Withdraw the speculum slightly to clear the
cervix. Loosen the speculum and allow the
"bills" to fall together. Continue to withdraw
while rotating the speculum to 45 degrees.

31.  Remove the draping.
 Reassure the patient, if the exam is normal so
far, say so.

33.  Apply a small amount of lubricant.
 Uncover the vulva and lower abdomen
 Announce what you are going to do and then
touch the patient.
 Spread the labia and insert your lubricated
index and middle fingers into the vagina.
 Avoid contact with the anterior structures.

34. Cervix :-
i. Palpate the cervix with your index finger
noting size, shape, and consistency.
ii. Gently move the cervix side to side between
your fingers and note mobility and
tenderness.
iii. Gently lift the cervix forward and note
mobility and tenderness.

35. iv. Examine the anterior uterine fundus.
iv. Continue to lift the cervix with the vaginal
hand.
v. Press downward with the abdominal hand
and palpate the uterus.
vi. Note consistency and tenderness. Attempt to
estimate uterine size.

36. • Pull back vaginal hand to clear cervix.
• Reposition vaginal hand into the right fornix, palm
up.
• Sweep the right ovary downward with the
abdominal hand 3 or 4 cm medial to the iliac crest.
• Gently "trap" the ovary between the fingers of both
hands (if possible). Note its size and shape along
with any other palpable adnexal structures.
• Pull back and repeat on the left side.

37.  Switch off the examination light
 provide privacy
 Ensure the woman has tissue available
 is access to washing facilities and sanitary
pads, if needed.
 Recording findings clearly in patient’s notes
 Provide correct information about the findings
and results of the examination.

38. If swabs are taken for screening following information
should be given.
How the results will be communicated.
When to expect results.
What to do if she does not get the expected results.
Possible outcomes.
Any further management.

39.  In estrogen deficiency (or following
menopause) the vaginal mucosa may be pale
with loss of rugae.
 Swelling of Bartholin’s glands could indicate
infection (discharge should be cultured).
 Pregnancy enlarges the cervix; cancer hardens
it.
 In PID the client will experience severe pain
when the cervix is manipulated.

41.  Blue-coloured cervix = pelvic congestion and
tumour or pregnancy.
 Infection may give the cervix a bright red or
spotted red appearance.
 A cervix projecting low into the vagina can
indicate uterine prolapse.
 A cystocele or rectocele may be observed in
clients with weak pelvic muscles.
 A laterally placed cervix can indicate tumour or
adhesions.

42.  Cervical ulcerations, masses, nodules or
surface irregularities must be assessed
carefully and considered malignant until
proven otherwise.
 Endocervical lining may protrude outwards
(ectropion or eversion).

43.  Polyps – bright red, fragile, soft
protrusions into the cervical canal
endocervical tissue.
 Small, smooth, round, raised yellow
cysts (Nabothian cysts) appear with or
after chronic cervicitis or with cervical
gland duct obstructions.

44.  Cervical carcinoma appears as hard, granular, friable
lesions usually beginning the os and growing outward
irregularly.
 Venereal warts (condolamata acuminata) are dark pink
to pale, cauliflower like lesions on the mucosal surface.
They may or may not be visible and resemble irregular
small pumps on the cervix.
 Ulcerations indicate trauma or infection (Herpes
simplex, type I or II).

46.  Trichomonal infection usually produces
strawberry spots (punctate haemorrhages).
 Tumourous uterus feels hard if cancerous.
 A palpable ovary in a postmenopausal woman
is abnormal.