Medically Fit For Exams
Medically Fit For Exams

Female genital examination

  • Wash hands and introduce yourself
  • Check the patient’s name and DOB
  • Explain the examination step by step and gain consent
  • Inform the patient that a chaperone will be present, can introduce them as an assistant
  • Ask her to undress from the waist down, and to lie on the bed, with a sheet to cover herself with
  • Allow her to undress behind a curtain
  • Put on gloves while you wait


General observation

  • Anaemia
  • Hirsuitism
  • Body habitus
  • Acanthosis nigricans
  • Demeanour


Abdominal examination

  • Light palpation in four quadrants
    • Assess face for discomfort
    • Feel for obvious masses
  • Deep palpation in 9 areas as above
  • Assess for organomegaly if appropriate


External examination

  • Ask her to remove the sheet and lie with her feet together and knees apart
  • Inspect the vulva and perineum






Surface and shape

Pulsation, thrills, bruits

Inflammation (red, tender, warm)


  • Spread the labia majora and minora to see all of the vulva, urethral meatus and vaginal introitus
  • Look for:
    • Scarring/abnormalities from childbirth
    • Lumps
    • Ulcers
    • Swellings
    • Skin changes
    • Discharge
    • Cliteromegaly
  • Part the pubic hair to look for lice
  • Palpate any swellings using SPACESPIT
  • Ask her to cough to assess for prolapse or incontinence


Speculum examination (if necessary)

  • Part the labia with the left hand
  • Lubricate the end of the speculum with your right hand
  • Insert the blades of the speculum vertically, fully insert
  • Rotate 90 degrees so blades are horizontal
  • Open the blades to see the cervix between them
  • Assess the cervix for any abnormalities
  • Take a smear sample if necessary
  • Women who have been pregnant may need a larger or longer speculum
  • Virgins may need a smaller speculum
  • If the woman finds the examination difficult, advise her to relax and breathe slowly. She can also attempt to insert the speculum herself

Bimanual examination (if necessary)

  • The woman should still be lying on her back with her legs bent and knees apart
  • Apply lubricating gel to the right index and middle fingers
  • Insert into the vagina and feel for the cervix
  • 85% of uteruses are anteverted, and the firmness of the uterus will be felt anterior to the cervix
  • In 15%, the uterus is retroverted, with the firmness of the uterus felt behind the cervix
  • Push your fingers into the posterior fornix and lift the uterus
  • Simultaneously push down on the lower abdomen gently with the left hand to feel the fundus
  • Place the left hand above the umbilicus and bring down, palpating the uterus for size, shape and regularity, noting any masses or tenderness
  • Move your internal fingers to the lateral fornix, and move left hand laterally above the umbilicus to assess for any masses lateral to the uterus (adnexal)
  • Repeat for the other side


  • Inform the patient that the examination is finished
  • Thank the patient and allow her to dress behind the curtain
Female genital examination.docx
Microsoft Word document [69.3 KB]

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