Overview
This lecture provides a step-by-step guide for medical students on performing a pelvic exam and Pap smear, including preparation, procedure, and post-examination steps.
Preparation and Patient Communication
- Explain the purpose and steps of the pelvic exam using clear, understandable language.
- Ensure the patient has adequate privacy while undressing.
- Provide instructions and reassurance before starting the exam.
External Genitalia Inspection
- Inspect the external genitalia first for any abnormalities.
Speculum Examination Setup
- Gather materials: appropriately sized speculum, gloves, cotton pledgets or cyto brush/broom, glass slide, and fixative.
- Glove the examining hand (right for right-handed, left for left-handed; optional to glove both).
- Hold the speculum with the ungloved hand and lubricate it with water.
Performing the Speculum Exam
- Separate the labia majora with the thumb and middle finger of the examining hand.
- Insert the speculum diagonally to avoid the urethra and rectum.
- Adjust the speculum to visualize the cervix, then lock it in place.
- Examine and report findings from the cervix and vaginal walls (discharge, color, consistency, odor, or erythema).
Collecting Pap Smear Samples (Three Coton Pled Technique)
- Collect samples from the endocervix, exocervix, and lateral vaginal walls.
- Smear each specimen on separate sections of the glass slide.
- Unlock and gently remove the speculum, then label the slide and apply fixative.
Bimanual and Rectovaginal Examination
- Gently separate the labia and insert examining fingers into the vagina.
- Place the non-dominant hand on the suprapubic area to examine the cervix, uterus (corpus), and adnexae.
- Withdraw fingers and perform a rectovaginal examination by inserting a finger into the anus.
- Gently withdraw and inform the patient the exam is finished.
Post-Examination Procedure
- Ask the patient to get dressed.
- Answer any of the patient's questions appropriately.
- Thank the patient after the examination.
Key Terms & Definitions
- Speculum — an instrument used to widen the vaginal opening for examination.
- Pap smear — a screening procedure to collect cells from the cervix for cervical cancer screening.
- Labia majora — the outer folds of skin surrounding the vaginal opening.
- Erythema — redness of the skin or mucous membranes.
- Adnexa — structures adjacent to the uterus, typically the ovaries and fallopian tubes.
Action Items / Next Steps
- Download the lecture deck from the lecturer’s WordPress site for reference.
- Practice the sequence and techniques described for exam proficiency.