46. Vaginal Examination

Learning outcomes

By the end of this section, you should know how to:

▪ prepare the patient for this procedure

▪ collect and prepare the equipment

▪ describe the various positions that enable this examination to be carried out most easily

▪ assist the examiner as necessary.

Background knowledge required

Revision of the anatomy and physiology of the female reproductive system

Revision of ‘Infection prevention and control’ procedures (seep. 151)

Revision of local policy on vaginal examination.

Indications and rationale for a vaginal examination

The vagina can be examined visually or digitally for the following reasons:

▪ to assess the position, size, texture or appearance of the cervix and vagina

▪ to obtain a swab from the cervix or vagina

▪ to obtain a cervical smear for cytological examination (see ‘Specimen collection’, p. 303)

▪ to administer treatment to the cervix or vagina

▪ to determine the site of a haemorrhage

▪ to insert an intrauterine contraceptive device.

Outline of the procedure

Prior to undertaking this procedure, the examiner will normally take a gynaecological history (Young 2002). The examiner puts on a pair of disposable gloves and applies some water-soluble lubricant to the dominant hand. Two or three fingers of the dominant hand are then inserted into the vagina, and the uterus is palpated through the abdominal wall with the non-dominant hand. This is known as a digital or bimanual examination.

For a visual examination of the vagina and cervix, the examiner will insert a lubricated speculum – usually a Sims’ or Cusco’s speculum (Fig. 46.1) – into the vagina. The speculum should be warmed in water to body temperature and the sides lubricated with water-soluble lubricant (Rawlinson 2002). The speculum is gently opened to separate the vaginal walls and enable an inspection of the vagina and cervix; a good light is required for this. A pair of vulsellum forceps may be used to hold the cervix while it is examined. A pair of swab-holding forceps and some swabs may be necessary to wipe away any blood or vaginal discharge that might be obstructing the inspection of the mucosa. After the examination, the speculum is closed and removed gently from the vagina.