Hesperian Health Guides
How to Examine the Genitals (the Pelvic Exam)
Knowing how to do a pelvic exam can save lives. It is necessary for using some family planning methods and for finding out about many serious health problems, such as pregnancy in the tubes, cancer of the cervix and of the womb (uterus), many STIs, and complications from abortion. It is not difficult to learn. With practice, you can learn to:
Move the cervix gently from side to side.
- examine the outer genitals.
- feel the reproductive parts inside the abdomen.
But only do a pelvic exam if it is really necessary. Any time you put something inside someone’s vagina, you increase the possibility of infection.
IMPORTANT! Do not do a pelvic examination:
- when a person is pregnant and bleeding, or after their waters have broken.
- after a normal birth or uncomplicated abortion.
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Contents
Before you start:
- Ask if the person needs to pass urine.
- Wash your hands well with clean water and soap.
- After clothing is removed or loosened, use a sheet or clothing to cover the genitals.
- Ask the person to lie back with knees up and apart, and to relax as much as possible. Explain what you are about to do.
- Put a clean glove on the hand you will put inside the vagina.
clitoris
opening of
the vagina
the vagina
anus
Look at the outside genitals:
Using your gloved hand to touch gently, look for lumps, swelling, unusual discharge, sores, tears, and scars around the genitals and in between the skin folds of the vulva. Some diseases have signs that appear on the outside of the genitals (see the chapter on STIs).How to do a speculum exam
A speculum is useful for looking at the cervix and vagina. If you have one, follow the steps below and then continue with the exam on the next page. If you do not have a speculum, you can get much of the same information by following the steps in How to feel the reproductive parts inside the abdomen.
- Be sure the speculum has been disinfected. Wet the speculum with warm, clean water or water-based lubricant before using it. Warming it is helpful and kind.
- Put the first finger of your gloved hand in the vagina. As you put your finger in, push gently downward on the muscle surrounding the vagina. (Work slowly, waiting for the muscles to relax.) Use this finger to find the cervix, which feels firm, like the tip of the nose.
- With the other hand, hold the speculum blades together between the pointing finger and the middle finger. Turn the blades sideways and slip them into the vagina. (Be careful not to press on the urine hole or clitoris, which are very sensitive.) When the speculum is halfway in, turn it so the handle is down. Remove your gloved finger.
- Gently open the blades a little and look for the cervix. Move the speculum slowly and gently until you can see the cervix between the blades. Tighten the screw on the speculum so it will stay in place.
- Check the cervix, which should look pink and round and smooth. Notice if the opening is open or closed, and whether there is any discharge or bleeding. If you are doing the exam because there is bleeding from the vagina after birth, abortion, or miscarriage, look for tissue coming from the opening of the cervix. If you think there is an infection, check for green or yellow discharge, or bleeding from the cervix. If there has been leaking urine or stool, bring the speculum blades closer together and gently turn the speculum to look at the walls of the vagina.
- To remove the speculum, gently pull it toward you until the blades are away from the cervix. Then bring the blades together and gently pull back. Be sure to disinfect your speculum again.
How to feel the reproductive parts inside the abdomen
- Put the pointing finger of your gloved hand in the vagina. As you put your finger in, push gently downward on the muscle surrounding the vagina. After the muscle relaxes, put the middle finger in too. Turn the palm of your hand up.
- Feel the opening of the womb (cervix) to see if it is firm and round. Then put one finger on either side of the cervix and move the cervix gently. It should move easily, without causing pain. If it does cause pain, there may be an infection of the womb, tubes, or ovaries. If the cervix feels soft, it may be a sign of pregnancy.
- Feel the womb by gently pushing on the lower abdomen with your outside hand. This moves the inside parts (womb, tubes, and ovaries) closer to your inside hand. The womb may be tipped forward or backward. If you do not feel it in front of the cervix, gently lift the cervix and feel around it for the body of the womb. If you feel it under the cervix, it is pointed to the back.
- When you find the womb, feel for its size and shape. Move your inside fingers to the sides of the cervix again, and then “walk” your outside fingers around the womb, pressing gently to feel its shape. It should feel firm, smooth, and smaller than a lemon.
- feels soft and large, this is a sign of pregnancy.
- feels lumpy and hard, this is a sign of a fibroid or other growth.
- hurts when you touch it, this is a sign of an infection inside.
- does not move freely, this may be caused by scars from an old infection (pelvic inflammatory disease or PID.)
- Feel for the tubes and ovaries. If these are normal, it will be hard to feel them. If you feel any lumps that are bigger than an almond (this size) or that cause severe pain, it could be an infection or other emergency. If there is a painful lump and the person’s menstrual period is late, it could be an ectopic preganancy (pregnancy in the tube). Get medical help right away.
- Move your finger to feel along the inside of the vagina. If the person has a problem with leaking urine or stool, check for a tear. Make sure there are no unusual lumps or sores.
- Ask the person to cough or to push down as if passing stool. Watch to see if something bulges out of the vagina. If it does, it could be a fallen womb or fallen bladder.
- When you are finished, dispose of your glove or clean and disinfect it if you will reuse it. Wash your hands well with soap and water.
Size of the womb during pregnancy
12 weeks
10 weeks
8 weeks
If the womb:
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This page was updated:22 Jan 2024