Line drawing showing palpation in pelvic exam.
Broadly, it can be divided into the external examination and internal examination.
It is also called "Bimanual Exam" & "Manual Uterine Palpation".
- examination of anatomy
- skin lesion
- palpation of stomach area
Use of speculum to locate external cervical os. Examination for foreign bodies and cervical swabs are taken at this point in the exam. These swabs of the epitelium layer of the cervix are known as a Pap smear. Other vaginal swabs can be taken at this time or STI testing.
Two fingers are inserted into the vagina until they isolate the cervix. Then the health care professional tests for cervical motion tenderness, as classically seen in pelvic inflammatory disease. The examiner palpates the uterus, including location of the fundus of the uterus and the adnexal structures.
The exam should not be excessively uncomfortable, but a woman with a vaginal infection may feel pain when the speculum is inserted. During the bimanual exam, the palpating of the ovaries may be painful. The pap test may cause some cramping as well.
For educational purposes, trainee doctors have performed pelvic exams on unconscious women. The subjects are those undergoing surgery for unrelated causes, and they were rarely informed the examination had occurred. This practice was forbidden in the United States and the United Kingdom, which now require the patient to consent in advance. The practice still continues in Canada according to a study published in the Journal of Obstetrics and Gynecology. The director of the Medical Health program at the University of Manitoba claimed in response that the revised 2006 guidelines of the Society of Obstetricians and Gynecologists of Canada forbade pelvic exams without consent, though the original impetus for the study of pelvic exams and consent was an incident in 2007.
- "Examination of the Female Pelvis". Retrieved 2007-12-09.
- "Pelvic exam - MayoClinic.com". Retrieved 2007-12-09.
- "Time to end pelvic exams done without consent". The Globe and Mail (Toronto). 2012-09-06.[dead link]