Speculum Examination

• I’m going to perform a speculum examination. What this involves is inserting a small plastic device into the vagina to allow me to visualise the neck of the womb. It won’t be painful but might be a little bit uncomfortable. Is that okay?
• The examiner will act as the chaperone. Are you in any pain before we begin?
• I’ll give you a moment to remove your underwear and lie on the couch, just let me know when your ready.
• Lithotomy Position → if you could bring your heels towards your bottom and let your knees fall fall to the sides.
• INSPECTION → inspect the vulva (I’m just going to start of by inspecting the vagina). Ask patient to cough (check for prolapse).
• INSERTING SPECULUM → warn patient you’re about to insert speculum + ask them to relax. Use index and thumb of left hand to seperate the labia. Insert speculum sideways. Once inserted, rotate so it is facing upwards. Open and then inspect the cervix. Gently remove speculum and insert in clinical waste bin.

Bimanual Examination

• I have been asked to perform a bimanual examination. Have you had one before? Do you understand what it involves?
• I will be using my gloved hand to insert two lubricated fingers into your vagina. This allows me to check for any abnormalities inside the vagina and around the neck of your womb. I will also be placing my other hand on your tummy at the same time. Might be a little uncomfortable but won’t be painful.
• The examiner will act as the chaperone. Are you in any pain before we begin?
• I’ll give you a moment to remove your underwear and lie on the couch, just let me know when your ready.
• Lithotomy Position → if you could bring your heels towards your bottom and let your knees fall fall to the sides.
• INSPECTION → inspect the vulva (I’m just going to start of by inspecting the vagina). Ask patient to cough (check for prolapse).
• INSERTING FINGERS → warn patient you’re about to put fingers in + ask them to relax. Use index and thumb of left hand to seperate the labia. Insert with thumb pointing up, as you enter rotate so palm is facing up. Place free hand 3-4cm above pubic symphysis to feel for position of the uterus. Withdraw fingers and check for any blood or discharge.

Examining Pregnant Abdomen

• Confirm gestational age + whether pregnancy is single/multiple.
• I have been asked to perform an examination of your tummy today. Have you had one before? Do you understand what it involves?