The gynaecological examination consists of different parts:
- External inspection
- Speculum examination
- Bimanual examination
They are each described in detail below. In practice, in the case of a specific query some parts or aspects will receive more attention than others.
Preparation
- Always ask the patient if she has an empty bladder before the gynaecological examination and offer her the opportunity to visit the lavatory beforehand.
- Give the patient clear instructions regarding undressing : lower body bare, socks and possibly skirt can be kept on. Inform the patient or indicate where she can get undressed.
- Consider which instruments and tools you need for the examination that you will be conducting and ensure that everything is within reach.
- Make sure that you have adequate lighting at your disposal: adjustable lamp, ready for use.
- Make sure that the examination table is covered with a clean paper towel.
- Do not wear jewellery and make sure that nails are short.
- Assist the patient with getting on the examination table; give instructions or help out if necessary.
- The patient should be seated properly on the examination table, not right on the edge.
- It is easiest to lie down and place the legs in the supports in one single movement.
- Then, ask patient to move her buttocks towards the edge of the examination table. The buttocks should be just at the edge of the examination table [Figures 19, 20].
- Check if the patient is lying down comfortably; if necessary, the leg supports can be slightly adjusted for height and degree of spreading. You can also check whether the patient is lying down comfortably by seeing whether she has her lower back in contact with the examination table. If necessary, remind the patient to do this.
- Put on a pair of gloves.
Figure 19: too high
Figure 20: too low
During the examination keep in mind what you want to know based on your hypothesis, what you will be doing and why you are doing it. Also record your findings and keep asking yourself what these findings mean for your working hypothesis: has it been confirmed or do you have to reject it?
Close-up overview of the examination