Hesperian Health Guides
How to Examine a Woman’s Genitals (the Pelvic Exam)
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Knowing how to examine a woman’s genitals can save lives. It is necessary for giving some family planning methods and for finding out about many serious women’s 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, and with practice, most women or health workers can:
- 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 a woman’s vagina you increase her risk of infection.
IMPORTANT! Do not do a pelvic examination:
- when a woman is pregnant and bleeding, or if her waters have broken.
- after a normal birth or uncomplicated abortion.
where others cannot see.
Before you start:
- Ask the woman to pass urine.
- Wash your hands well with clean water and soap.
- Ask her to loosen her clothing. Use a sheet or her clothing to cover her.
- Have her lie on her back, with her heels close to her bottom and her knees up. Explain what you are about to do.
- Put a clean glove on the hand you will put inside the vagina.
Look at the outside genitals:Using the gloved hand to gently touch the woman, 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 feel the reproductive parts inside the abdomen
- Put the pointing finger of your gloved hand in the woman’s vagina. As you put your finger in, push gently downward on the muscle surrounding the vagina. When the woman’s body relaxes, put the middle finger in too. Turn the palm of your hand up.
- Feel the opening of her 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, she may have an infection of the womb, tubes, or ovaries. If her cervix feels soft, she may be pregnant.
- Feel the womb by gently pushing on her 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. Do this by moving your inside fingers to the sides of the cervix, and then ‘walk’ your outside fingers around the womb. It should feel firm, smooth, and smaller than a lemon.
- feels soft and large, she is probably pregnant.
- feels lumpy and hard, she may have a fibroid or other growth.
- hurts when you touch it, she probably has an infection inside.
- does not move freely, she could have scars from an old infection (pelvic inflammatory disease – PID).
- Feel her tubes and ovaries. If these are normal, they will be hard to feel. But if you feel any lumps that are bigger than an almond or that cause severe pain, she could have an infection or other emergency. If she has a painful lump, and her monthly bleeding is late, she could be pregnant in the tube. She needs medical help right away.
- Move your finger and feel along the inside of the vagina. If she has a problem with leaking urine or stool, check for a tear. Make sure there are no unusual lumps or sores.
- Have the woman cough, or push down as if she were passing stool. Watch to see if something bulges out of the vagina. If it does, she could have a fallen womb or fallen bladder.
- When you are finished, clean and disinfect your glove. Wash your hands well with soap and water.
If the womb: