General Principles
The majority of women have varying degrees of anxiety about vaginal examination.
Examination is usually more informative in a relaxed patient and a number of simple measures can be used to make the patient feel at ease.
Women should be given an appropriate area to change in privacy. A sheet should be provided to allow the woman to cover herself. A chaperone should be present for any intimate examination. This should apply for both male and female practitioners. The chaperone provides two purposes, firstly as a source of support and distraction for the patient but also to provide evidence that no improper behavior has taken place.
Formal consent should be given for any intimate examination by a student including under anesthesia.
An explanation of the purpose of the examination should be given to the woman and permission sought to perform the examination. Simple terms should be used to explain the likely sensations experienced. The examination should be thorough but gentle. The patient should feel confident that you will stop the examination if she wishes.
Abdominal Examination:
This must never be omitted, whatever be the patient’s complaint.
- Many gynecological tumors form large swellings, which could be palpated on abdominal examination.
- Also an abdominal examination may reveal an undisclosed pregnancy
- Always examine the upper abdomen.
- Be certain that the bladder is empty.
- Ask the patient to tell you if you are hurting her.
All the classical techniques of inspection, palpation, percussion and auscultation are advised, but the most important is gentle palpation with the flat of the hand to detect solid or semi-solid tumors.
The examiner must bear in mind the various intra-abdominal structures which may give rise to swellings.
