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The Patient

  • General Features

    Age, general comfort

  • Body Habitus

    Weight (change), BMI

The External Genitalia

  • Prepare

    Consent, chaperone, undress, position

  • Lesions

    Ulcers, masses

  • Erythema

  • Atrophy

  • Discharge / Blood

    Colour, consistency

  • Hair Distribution

  • Clitoris

    Clitoromegaly

  • Bartholin's and Skene's Glands

    Abnormal if palpable

  • Urethral Meatus

  • Uterovaginal Prolapse

    Ask the patient to cough

Cervical Examination

  • Prepare

    Consent, chaperone, undress, position

  • Insert Speculum

    Use the smallest speculum that allows for adequete visualisation; avoid lubricant if cytology sampling

  • Cervical Inspection

    Erythema, lesions, discharge, blood

  • Cytology Sampling

    Ectocervix (spatula), endocervical canal (brush)

  • Cultures

    If indicated

  • Vaginal Inspection

    While withdrawing the speculum, blades partially open

    Erythema, lesions

Bimanual Examination

  • Vagina

    Tenderness, masses

  • Cervix

    Position, consistency, dilatation, excitation

  • Uterus

    Size, mobility, position, shape

  • Adnexa

    Masses

References

 Bohl TG. Vulvar ulcers and erosions-a dermatologist's viewpoint. Dermatologic therapy. 2004 Mar 1;17(1):55'67. Da Costa D, Taddese A, Cure ML, Gerson D, Poppiti Jr R, Esserman LE. Common and Unusual Diseases of the Nipple-Areolar Complex 1. Radiographics. 2007 Oct;27(suppl_1):S65-77. Eckert L, Hawes SE, Stevens CE, Koutsky LA, Eschenbach DA, Holmes KK. Vulvovaginal candidiasis: clinical manifestations, risk factors, management algorithm. Obstetrics & Gynecology. 1998 Nov 30;92(5):757-65. Herrada J, Iyer RB, Atkinson EN, Sneige N, Buzdar AU, Hortobagyi GN. Relative value of physical examination, mammography, and breast sonography in evaluating the size of the primary tumor and regional lymph node metastases in women receiving neoadjuvant chemotherapy for locally advanced breast carcinoma. Clinical Cancer Research. 1997 Sep 1;3(9):1565-9. Kalbhen CL, Kezdi-Rogus PC, Dowling MP, Flisak ME. Mammography in the evaluation of nipple inversion. AJR. American journal of roentgenology. 1998 Jan;170(1):117-21. Kingsberg SA, Wysocki S, Magnus L, Krychman ML. Vulvar and vaginal atrophy in postmenopausal women: findings from the REVIVE (REal Women's VIews of Treatment Options for Menopausal Vaginal ChangEs) survey. The journal of sexual medicine. 2013 Jul 1;10(7):1790-9. Lewis FM, Velangi SS. An overview of vulvar ulceration. Clinical obstetrics and gynecology. 2005 Dec 1;48(4):824-37. Padilla LA, Radosevich DM, Milad MP. Accuracy of the pelvic examination in detecting adnexal masses. Obstetrics & Gynecology. 2000 Oct 1;96(4):593-8. Park CA, David LR, Argenta LC. Breast asymmetry: presentation of a giant fibroadenoma. The breast journal. 2006 Sep 1;12(5):451-61.
Risser JM, Risser WL. Purulent vaginal and cervical discharge in the diagnosis of pelvic inflammatory disease. International journal of STD & AIDS. 2009 Feb;20(2):73-6.
 Scutt D, Lancaster GA, Manning JT. Breast asymmetry and predisposition to breast cancer. Breast cancer research. 2006 Mar 20;8(2):R14. Scutt D, Manning JT, Whitehouse GH, Leinster SJ, Massey CP. The relationship between breast asymmetry, breast size and the occurrence of breast cancer. The British journal of radiology. 1997 Oct;70(838):1017-21. Simmons R, Adamovich T, Brennan M, Christos P, Schultz M, Eisen C, Osborne M. Nonsurgical evaluation of pathologic nipple discharge. Annals of surgical oncology. 2003 Mar 1;10(2):113-6. Sobel JD. Vaginitis. New England Journal of Medicine. 1997 Dec 25;337(26):1896-903.

Snapshot: Initialising...