Pelvic Exam Tutorial

We're now going to begin the pelvic examination. Ms. Wood, may I ask if you would lie back please and place your heels in the heel support and if you'll bring your body down to the end of the table and would it be possible to move the drape up toward your waist? The first part of the pelvic examination consists of inspection of the external genitalia. We first notice the hair distribution, the clitoris, the labia majora, the labia minora, the clitoral hood, the foreshad, the perineum, and the anus.

Ms. Wood, I'm going to just palpate you our area over here. We now open the introitis and it's important to recognize that the barfilim glands are approximately here at 4 and 8 o'clock and the ducts exit in this area. I'm going to gently enter the introitis. Does this cause any tenderness? Here and here. Okay, did that cause any discomfort? No. If this causes you any discomfort, please let me know. We're now going to begin the speculum examination. So Jean, if you can lubricate the speculum please. Thank you, Jean.

We always use water as the lubricant because any other agent such as surge lube may actually interfere with the pap smear determination. The speculum is an instrument which has two bills which open like this and has a set screw which locks the bill in an open position. Once the speculum is inserted, I will open the bills to open the vagina for visualization of the cervix. Place the speculum into the vagina by first applying firm pressure posteriorly with two fingers which are being inserted now into the vaginal atroitis.

I'm going to insert my fingers into your vagina and as I press down posteriorly, I will insert the speculum over my fingers and down in through the vaginal atroitis. As it is inserted, I'm going to turn horizontally. Is that causing any discomfort? I'm now going to open the bills of the speculum to visualize the cervix. The cervix is easily visualized, inspected for discharge, erythema, erosion, ulceration, leukoplakia, or masses. We are now going to do a pap smear. May I have the spatula, please? This is a spatula for pap smear determination.

It's inserted through the speculum and is placed at the external cervical osse. The spatula is twirled scraping off cells from the external cervical osse. We now take a microscopic slide and we smear the cells on the microscopic slide. May I have another spatula, please? We're now going to evaluate cells in the fornices around the cervix. This specimen is from the posterior fornix. The speculum is now going to be withdrawn slowly and we're going to gently withdraw it as we evaluate the vaginal walls. The next part of the pelvic examination

is the bimanual examination.