This document provides guidelines for performing a gynecological examination. It details the steps of taking a patient history, including menstrual, obstetric, medical, and family histories. It then describes examining the breasts, abdomen, and pelvis through inspection, palpation, percussion and auscultation. The pelvic exam involves speculum, digital, bimanual, and rectal examinations. Common investigations like blood tests, urine analysis, and endoscopic procedures are also summarized. The goal is to obtain all relevant information to arrive at an accurate diagnosis.

1. SKRP Gujarati Homoeopathic Medical College Hospital & Research centre

3.  Introduction
 Gynecological history
 General examination
 Breast examination
 Abdominal examination
 Pelvic examination - Digital and
speculum examination
 Investigations

4.  Gynecological history coupled with
a systemic examination would help
in arriving at the correct diagnosis.
 A good history taking ,alone can
give a positive diagnosis without
any physical examination.

5. •The examination should, in fact
proceed with the provisional
diagnosis in mind.
•Patients privacy should be
respected always .
•A brief outline of history taking is
given below:

7.  History should be taken in details.
 If multiple symptoms are present,
their chronological appearances are to
be noted.
 Enquiry should be made about the
bowel habits and urinary troubles if
any.

8.  MENSTRUAL HISTORY
 OBSTRETIC HISTORY
 PAST MEDICAL HISTORY
 PAST SURGICAL HISTORY
 FAMILY HISTORY
 PERSONAL HISTORY

9.  Inquiry should be made about:
 First menarche(age of onset of first
menstrual period)
 Regularity of cycle
 Duration of period
 Length of the cycle
 Amount of bleeding excess is indicated
by clots and number of pads used.
 First day of last menstrual period(LMP)

10.  If the patient had been previously
pregnant then details should be
noted.
 Some times, the complaints may be
related due to the pregnancy or
lactation complications.

11.  The details should be noted in following
way
No. Date Year
&events
Pregnancy
details
Labour
details
Method of
delivery
puerperium Baby wt &sex
birth asphyxia.
duration of breast
feeding,
contraception
1
2

12.  The following disorder should be
noted
 Systemic
 Metabolic
 Endocrinal(diabetes, hepatitis,
hypertension)
 Sexual transmitted disorder

13.  This includes
 General
 Obstetrical
 Gynecological surgery
 Nature of operation
 Bleeding or clotting complication
 Post operative care
 Any histopathologiacal disorder

14.  It is of occasional value .
 Malignancy of breast,ovary,colon are
often related.
 Tubercular infection in family can also
give clue about pelvic tuberculosis

15.  Occupation
 Marital status : widow, single,
married.
 If married then sexual history should
be taken.
 Contraceptive practice, if any, should
also be inquired.

17.  Gynecological examination confirms
presence of pathology suspected from the
gynecological history.
 Always explain to the patient the need and
the nature of the proposed examination.
 Obtain an informed verbal consent.
 The examiner (male or female) should be
accompanied by another female
(chaperone).
 Examination performed in a private
setting, respecting patient's privacy at all
times.
 Patient should be covered at all times and

18.  BUILT: to obese or too thin. May be
due to any endocrinopathy.
 NUTRTION: average/ poor
 STATURE: including development of
secondary sex characters.
 PALLOR
 JAUNDICE

19.  OEDEMA OF LEGS
 TEETH GUMS AND TONSILS
 NECK: palpation of thyroid gland and
left Supraclavicular glands
 CARDIOVASCULAR AND
RESPIRATION SYSTEMS: any
abnormality if present
 PULSE
 BLOOD PRESSURE

20.  BREAST EXAMINATION
 ABDOMINAL EXAMINATION
 PELVIC EXAMINATION

21. Inspection with arms by her
side
Inspection with arms Raised above Inspection with Hands at waist
Palpation of axillary node Palpation of Supraclavicular node Palpation of Other half of breast

22.  It should be routine examination in
women above the age of 30
 POSITION: patient reclining at 45
degrees with arms at the sides
 INSPECTION – positions at rest, arms
above head, on hips
1) Development and symmetry of
breasts and nipples.
2) Reddening of skin, ulceration or
dimpling (peau d'orange)
3) Retraction of nipple (CA breast)
4) Nipple discharge- blood, serous or
milky

23.  PALPATION- palpate systematically
for lumps with the flat part of the
fingers, through all 4 quadrants. If
present, describe the characteristics
of the lump- location, size, shape,
surface, edge, consistency and mobility
in relation to deep and superficial
structures.
 Palpate the axillae for lymph nodes –
describe if present

24.  PREREQUISITE
 Bladder should be empty, if there is
history of chronic retention of urine,
then do catheterisation.
 The patient is to lie flat on table
with thigh slightly flexed and
abducted to make abdominal muscle
relaxed.
 The physician should stand on right
side
 Presence of female for the support of

25.  INSPECTION: Assess for distension,
scars (operative, traumatic or
scarification), distended veins, striae,
pubic hair distribution.
 PALPATION: Palpate the abdomen
systematically in all 9 regions
1) Superficial palpation- assess for
tenderness, guarding and rebound
tenderness
2) Deep palpation- assess any enlargement
of intra-abdominal organs (uterus, liver,
spleen etc) and for any abnormal

26. Describe any abnormal mass in terms of:
 SIZE, SHAPE
 POSITION-
 MOBILITY- movable or fixed
 SURFACE - e.g. smooth or nodular
 CONSISTENCY - e.g. solid or cystic
 TENDERNESS (pain on palpation)

27.  PERCUSSION:
 A pelvic tumor is usually dull and
resonance on flanks
 Assess for ascites using shifting
dullness and fluid thrill
 AUSCULTATION: Listen for bowel
sounds or for fetal heart rate in
pregnancy.
 Uterine soufflé can also be heard in
pregnancy.

28.  This includes
 Inspection of external genitalia
 Vaginal examination
 Inspection and palpation of cervix and
vagina walls
 Rectal examination
 Rectovaginal examination

29.  Sims position
 Dorsal position
 Lithotomy position

33.  To note any :
 Anatomical abnormality starting form
pubic hair, clitoris, labia and perineum.
 Palpable pathology
 External urethral meatus and opening
of bartholin duct and character of
hymen.
 To ask the patient to strain to elicit:
 To see stress incontinence
 Genital prolapse
 Lastly look for hemorrhoids

34.  INSPECTION OF VAGINA AND
CERVIX
Speculumexamination
Digital examination
Bimanual examination

35.  Most Preferably used.
 Advantages are:
 Cervical scrape cytology and
endocervical sampling can be taken
for screening.
 Cervical or vaginal discharge can be
taken for bacteriological examination.

36.  TWO TYPE OF SPECULUM IS USED
Sims'sspeculum Cusco’svalve

37.  In dorsal position Cusco's valve is
used, while in lateral – sim’s
speculum.
 Cervix is best seen by Cusco's valve
 Vaginal fornices can only be seen by
Cusco's valve while anterior wall of
vagina can be seen by sim’s speculum.

38.  Done by using gloved index finger
lubricated with sterile lubricant.
 In virgins done under anesthesia.
 To note
 Palpation of any labial swelling
 Pressing of urethra from above down
ward to see any discharge escaping out.
 Palpation of vaginal walls to detect any
abnormality

39.  Palpation of vaginal portion of cervix
 To note
 Direction-in anteroverted uterus ant. lip is
first felt & in retroverted position
external-os or post. lip is felt.
 Station-external-os is at level of ischial
spine
 Texture- in nonpregnant stage firm.
 Shape- conical in multipara and cylindrical
in nullipara.
 Ext.os –smooth and round in nullipara and
dilated in parous
 Movement-painful or not

40.  Done by using gloved index finger
lubricated with sterile lubricant.
 Gloved right index and middle finger
is inserted in to the vagina,if
intortius is narrower then only one
finger is used.
 The left hand is placed on the
hypogastrium well abdomen above the
symphysis pubis so that the organs
can be palpated.

41.  PALPATION OF UTERUS
 PALPATION OF UTERINE APPENDAGES
 POUCHOF DOUGLAS

42.  Note its position size shape consistency
 and mobility
 Normally the uterus is anteverted, pear
shaped firm, freely mobile in al
directions.

45.  Normally uterine tube cannot be
palpated.
 Normal Ovary cannot be palpated.
 If palpated, it is mobile and sensitive to
manual pressure.

47.  Normally faecal mass in rectosigmoid
and the body of retroverted uterus is
felt.

48.  Uterine tumor:
 Uterus is not separated from mass
 Movements of mass felt per abdominally
transmitted to the cervix.

50.  Adnexal mass:
 uterus is separated from mass
 Movements of mass are not transmitted
to the cervix.

53.  Indication for rectal examination:
 Children or in adult virgins.
 Painful vaginal examination
 Ca of cervix
 Abnormal findings in pouch of Douglas
during bimanual examination
 Artesia of vagina
 Patient having rectal symptoms

55.  In this procedure, gloved index finger
is introduced n vagina and middle finger
is introduced in rectum
 Helps in determining whether the lesion
is in bowel or between rectum and
vagina .

57.  Blood values
 Urine
 Urethral discharge
 Vaginal or cervical discharge: done by
Cusco's bivalve speculum

58.  Hemoglobin estimation: in cases of
excessive bleeding.
 TLC & DLC,
 ESR
 Platelet count in cases of puberty
menorrhagia.
:diagnosis of pelvic inflammati

59.  For the presence of protein sugar pus
cell casts are done .
 In the presence of excessive of vaginal
discharge midstream urine is taken
 Culture &drug sensitivity test:
 Midstream collection
 Catheter collection
 Suprapubic bladder puncture

60.  Bacteriological study:
 Cusco's bivalve speculum is inserted
without lubricant sample is taken via
sterile cotton sterile swab and sent for
culture.

61.  Hormonal status:
 cervical secretion is dependent on
hormones estrogen and progesterone
the influence of these hormones helps
in detection of time of ovulation.
 Normal Ph of cervical mucus during
ovulation is about 6.8-7.4.

62.  Cervical mucus shows characteristic
fern pattern formation.
 The ferning disappears completely
after 21st day .

63.  Presence of ferning even after the 21st
day indicates anovulation and its
absence gives evidence of ovulation.

64.  Colposcopy
 X-ray
 Ct scan
 Ultrasoun
d
 MRI

65.  Uses
 Can be helpful in locating IUCDs,
benign tumors etc.

66. Bilateral ovarian cystic masses

67. ENDOSCOPY
 Culdocentesis
 Laparoscopy
 Hysteroscopy
 Salpingoscopy

68.  Done by colposcope.
 Use: magnify the surface
epithelium of the vaginal
part of the cervix
including entire
transformation zone

70.  Aspiration of peritoneal fluid from
pouch of doulas.

71.  Visualization of peritoneal cavity by
means of a fiber optic endoscope.

72.  Visualization of endometrial cavity by
means of a fiber optic telescope

73.  Visualisation of uterine tubes.
FIMBRIA
TELESCOPE
UTERINE TUBE