This document provides an overview of components of a gynecological examination. It describes examination of the breasts, abdomen, vagina, vulva, cervix, and bimanual examination of the uterus and adnexa. It also discusses procedures like speculum examination and Pap smear. Heavy menstrual bleeding and its evaluation are covered along with amenorrhea, positions of the uterus, and examination of patients with uterine/vaginal prolapse.

2. Components of gynecological
examination
 General physical examination
Breast examination
Abdominal examination
Vaginal examination
Inspection of vulva vagina
Speculum examination
Pap smear / HVS
Bi-manual examination

3. Inspection of vulva

4. Speculum examination
sim’s speculum/single valve Cusco’s speculum/bivalve

5. Cervical examination

6. Cervical examination
Cervical polyp Vaginal discharge

7. PAP smear
• This is a method by which scrapings of
superficial cells from the external os and lower
endocervix are taken by means of special
spatula or cytobrush on a glass slide and are
fixed with 95% ethinyl alcohol and air dryed.
• This preparation is then stained with
“Papaniculaou stain” and then examine under
microscope.

8. How to take PAP smear

9. How to take HVS

10. Bimanual examination

11. Uterine palpation
Normally not palpable abdominally.
If it is palpable size is above 12 cm.
Non tender and centrally placed firm freely
mobile, fornix free
Anteverted : forward tilt of uterine axis to
vaginal axis. Cx is directed backward
Retroverted: backward tilt in relation to vaginal
axis, cx is directed upward.
Anteflexed: forward tilt in relation to cx
Retroflexed: backward tilt in relation to cx

12. Positions of uterus

13. Clinical interpertations
 enlarged uterus: pregnancy, fibroids,
adenomysosis, malgnancy.
Tenderness: PID, adenomyosis, endometrosis,
ectopic pregnancy, complications of pelvic mass
(infection, tortuion, rupture, degenration.
Ristricted moblity: endometrosis,
infections,PID, big mass, malgnancy.

14. Adnexal masses
Overian mass : cysts, benign and malgnant
tumors, ectopic pregnancy, endometroma.
Hydrosalpinx.
 adnexa comprises of overy and fallopian tube
lie bilaterally to uterus and palpated through
lateral fornixes bimaually, normally adnexa are
not palpable except thin lean lady.

16. HEAVY MENSTURAL BLEEDING
• Excessive menstural blood loss (over several
consecutive cycles) that has major effect on
woman’s quality life.
• HBM : defined as blood loss of greater than
80ml per mensturation is no longer used except
for research purpose.
• Abnormal bleeding AUB is irregural in cycle,
abnormal volume and with post coital and inter
menstural bleeding.

17. EXAMINE THE PATIENT WITH HMB
Look for evidence of Iron deficiency: pallor
smooth tongue ,koilonychia , angular
stomatitis.
Examine the patient’s abdomen for any mass
arising from the pelvis.
Perform a speculum examination to check the
cervix for any polyps and prolapsing fibroids.
Assess amount of bleeding,vaginal discharge.
Perform bi-manual to assess uterus for size and
any mass and tenderness

18. Continued….
In addition : look for the signs of non
gynecological disease leading to heavy
menstural bleeding: purpura, petechiae,
hypothyroidism; obesity, connective tissue
disorders, CLD, signs of malgnancy etc.

19. Amenorrhoea
Amenorrhoea is the absence of menses.
Primiry: Mensuration has not occurred by the
age of the 14 in the absence of secondary sexual
characters or by the age of 16, even if secondary
sexual characters are present.
Secondery: periods have not occurred for six
months in previously mensurating woman.

20. Examination of woman with
Amenorrhoea
Take hight and weight and BMI
Examine axillary, pubic hairs and breast
development
Any abnormal hair distribution in male pattern
(hirustism)
Galactorrhea
Visual field defects
Abdominal mass: pregnanacy, hematometra

21. Continued….
Previous surgery marks
Genital examination: imperforated hymen,
vaginal septum,cliteromegally.
Signs of turner syndrome
Any other signs of chronic illness

22. Uterovaginal prolapse
• Protrution of uterus or vagina beyound the
normal anatomical confines(position)
• 1st Degree : descent within the vagina
• 2nd Degree : descent to the introitus
• 3rd Degree : descent out side the introitus

23. Examination of patient with UV
prolapse
Mostly menopausal
Chest examination for signs of chronic lung
disease
Abdominal examination for distention masses
ascites
Hyper flexability of joints
Prolapse: degree of prolapse, ulcer, bleeding
reducbility, associated stress incontinence

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