Method Of Exam

• Speculum technique
  • To prepare for an adequate examination, the patient should be given an opportunity to empty her bladder and should be draped appropriately.
  • The examiner should use warm gloved hands and a warm speculum.
  • Each step of the examination should be explained in advance to the patient.
  • Always do pelvic exam chaperoned.
  • Ask the patient to assume the lithotomy position.
  • Select an appropriately sized speculum, warmed with water.
  • Do not lubricate your gloved fingers, as this may intefere with papsmear.
  • Place two fingers just inside or at the introitus and gently press down on the perineal body.
  • With your other hand, introduce the closed speculum past your fingers at a 45^o angle downward.
  • The blades should be held up obliquely and the pressure exerted towards the posterior vaginal wall, avoiding the more sensitive anterior wall and urethra.
  • After the speculum has entered the vagina, remove your fingers from the introitus.
  • Rotate the blades of the speculum into a horizontal position.
  • Open the blades after full insertion and maneuver the speculum gently so that the cervix comes into full view.
• Inspection
  • Cervix
    • Note the color of the cervix
    • Describe the mucous membrane
    • Position of Cervix
  • Cervical os
    • Appearnce and location
    • Mucous membrane
    • note the nature of discharge.

  Normal:

  • Cervical os is small and round in nulliparous and slit like after child birth.
  • The cervix is covered by smooth pink epithelium.