Hesperian Health Guides
How to Examine the Genitals
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:
- 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.
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.
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 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.
- 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.
If the womb: