This document provides instructions for performing a pelvic exam, including positioning the patient, inspecting external genitalia, performing a vaginal exam with a speculum, examining the cervix, conducting a Pap smear, and performing bimanual and rectovaginal exams to evaluate the uterus, ovaries, and surrounding structures. The examiner is guided to palpate for abnormalities and take note of characteristics like size, shape, tenderness, and masses at each stage of the internal and external evaluation.

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tevfik@yoldemir.com
Tevfik Yoldemir, MD, BBA
Marmara University
Department of Obstetrics and Gynecology
Division of Reproductive Endocrinology and
Infertility
PELVIC EXAM
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PositioningPositioning
Move the pillow down to her headMove the pillow down to her head
Help her place her heels into the stirrupsHelp her place her heels into the stirrups
Buttocks are on the edge of the tableButtocks are on the edge of the table
Ask her to relax her legs to the sideAsk her to relax her legs to the side
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Lithotomy PositionLithotomy Position
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External GenitaliaExternal Genitalia
Mons pubisMons pubis
Tanner’s pubic hair distributionTanner’s pubic hair distribution
Excoriations or papules (lice)Excoriations or papules (lice)
Labia minora and majoraLabia minora and majora
Bartholin’s glandsBartholin’s glands
InflammationInflammation
UlcerationUlceration
NodulesNodules

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External GenitaliaExternal Genitalia
ClitorisClitoris
Clitoromegaly: Enlarged clitorisClitoromegaly: Enlarged clitoris
Milk urethraMilk urethra
Urethral diverticulumUrethral diverticulum
Periurethral glandsPeriurethral glands
UrethritisUrethritis
HymenHymen
Perineal bodyPerineal body
ScarsScars
AnusAnus
External hemorrhoidsExternal hemorrhoids
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BARTHOLIN’S CYSTBARTHOLIN’S CYST
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Gynecologic ExamGynecologic Exam
Separate the labia:Separate the labia:
Ask the patient to coughAsk the patient to cough
Supine stress testSupine stress test
Ask the patient to bear downAsk the patient to bear down
CystocoeleCystocoele
RectocoeleRectocoele
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Vaginal ExamVaginal Exam
Warm the speculumWarm the speculum
Lubricate the speculum with water or gelLubricate the speculum with water or gel
Good lightingGood lighting
Have supplies for Pap smear and culturesHave supplies for Pap smear and cultures
Use the correct size of speculumUse the correct size of speculum

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Inserting the speculumInserting the speculum
Choose the right sizeChoose the right size
Lubricate the speculumLubricate the speculum
Separate the labia with your other handSeparate the labia with your other hand
Avoid the urethraAvoid the urethra
Angle the speculum downwardAngle the speculum downward
Open the speculum when fully inserted toOpen the speculum when fully inserted to
visualize the cervixvisualize the cervix
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Inspect the cervixInspect the cervix
Squamocolumnar junctionSquamocolumnar junction
ColorColor
UlcerationsUlcerations
MassesMasses
BleedingBleeding
DischargeDischarge
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Normal CervixNormal Cervix
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Cervical EctopyCervical Ectopy

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Papanicolaou smearPapanicolaou smear
Spatula: Put the longer end in the os and turnSpatula: Put the longer end in the os and turn
360 degrees360 degrees
Cervical brush: Insert into the os and turn 360Cervical brush: Insert into the os and turn 360
degreesdegrees
Smear the slide and immediately use aSmear the slide and immediately use a
fixativefixative
Obtain cultures from cervix and swab fromObtain cultures from cervix and swab from
posterior fornixposterior fornix
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As you withdraw the speculum, open itAs you withdraw the speculum, open it
slightly to avoid pulling on the cervixslightly to avoid pulling on the cervix
Observe all four walls of the vaginaObserve all four walls of the vagina
DischargeDischarge
UlcersUlcers
MassesMasses
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Bimanual ExamBimanual Exam
Lubricate the index and middle fingersLubricate the index and middle fingers
Insert your fingers pressing posteriorlyInsert your fingers pressing posteriorly
Palpate the vaginal fornicesPalpate the vaginal fornices
Palpate the cervixPalpate the cervix
PositionPosition
ShapeShape
Motion tendernessMotion tenderness
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Bimanual ExamBimanual Exam
Palpate the uterusPalpate the uterus
Place your otherPlace your other
hand on thehand on the
abdomen aboveabdomen above
the pubicthe pubic
symphysissymphysis
SizeSize
ShapeShape
TendernessTenderness
MassesMasses
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Bimanual ExamBimanual Exam
Palpate the ovariesPalpate the ovaries
Place your vaginalPlace your vaginal
hand to the side ofhand to the side of
the cervix, yourthe cervix, your
opposite hand in theopposite hand in the
same side lowersame side lower
abdominal quadrantabdominal quadrant
SizeSize
ConsistencyConsistency
TendernessTenderness
MobilityMobility
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Rectovaginal ExamRectovaginal Exam
Change glovesChange gloves
Lubricate your fingersLubricate your fingers
Insert the index finger intoInsert the index finger into
the vagina and the middlethe vagina and the middle
finger into the rectumfinger into the rectum
Ask the patient to bearAsk the patient to bear
downdown
Palpate the posterior cervixPalpate the posterior cervix
Palpate the uterosacralPalpate the uterosacral
ligamentsligaments
Palpate the rectovaginalPalpate the rectovaginal
septumseptum
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Complete the examComplete the exam
Offer her a washcloth to remove theOffer her a washcloth to remove the
lubricantlubricant
Help her to a sitting positionHelp her to a sitting position
Explain the findings and the testsExplain the findings and the tests
performedperformed