Pelvic examination

This is my script for a pelvic examination. Everyone has their own, so feel free to chop and change it how you like.

Introduction:

·         “Hello, Mrs Jones, I’m Will Sloper, one of the doctors here, how are you doing today?”

·         “Can I check your date of birth quickly?”

·         “May I double check that you know what it is you’ve come here for today? Have you had one before?"

·         “Excellent, and do you understand why we do this test?”

o   Not a clue

§  “This exam is a routine test that we offer to all women over the age of 25, and it allows us to see whether there is a risk of cervical cancer further down the road. It’s not a test for cancer now, it just lets us intervene nice and early should we need to, alright?”

·          “Would you like me to explain what I’ll be doing?”

o   Yes

§  “There are two parts of today’s exam, the first is the smear test, and the other is a manual examination”

·         “For the smear test, I’ll use a soft little brush to take some cells from the cervix, so that we can send these cells off to the lab. To do this, I’ll gently insert a speculum, which will just hold the vaginal walls open so that I can see the cervix. It’ll be lubricated to make it more comfortable. Would you like to see the speculum beforehand?”

o   Yes

§  “Here’s an example, of course I’ll be using a sterile one in the examination itself”

·         “The second part of the exam is the manual exam. For this I’ll gently insert two fingers, with gloves on, into the vagina, and with the other hand I’ll press gently on your tummy. This will allow me to check that all of the reproductive organs are healthy. Is that alright?”

·         “Neither of the two parts should hurt, but they can be a little uncomfortable. It’s important that you know that you can say stop anytime, and I’ll stop straight away.”

·         “Having explained the procedures, do I have your consent to go ahead?”

Preparation:

·         “First of all do you need to go to the toilet? I will be pressing on your tummy”

·         “There will be a chaperone present, is that alright?”

·         “Would you like me to lock the door? The curtain will be drawn, but sometimes people walk in without knocking”

·         “Lastly, have you had any children?”

o   “Was that through normal delivery or Caesarean section?”

·         “Ok great, if you could head behind the curtain, and undress from the waist down, you can leave shoes and socks on if you’d prefer. If you lie on the bed, there’s a towel to cover yourself, and I’ll be in in a minute”

Wash hands

Get trolley ready:

·         Wipe with tissue and alcohol gel

·         Cover with tissue

·         Prepare the vial

o   Full name and DOB

o   Remove lid, discard seal

·         Place cytology brush on trolley

·         Squirt some lubricating jelly onto the trolley, and put the jelly down somewhere else

·         Select speculum and empty onto the trolley

o   Small if no children/caesarean

o   Medium if vaginal delivery

“Alright Mrs Jones, are you ready?"

Alcohol gel

1.       Abdominal examination

·         “Please could I ask you to slide your top up so I can have a look at your tummy first”

·         Visual inspection

o   Abdominal masses

o   Scars

o   Bruising

·         “Have you had any pain in this area?”

·         Abdominal examination

o   Press abdomen from umbilicus to pubic bone, across the width of the abdomen

o   Masses and tenderness

2.       Smear test

·         Put on gloves (NOW BE THINKING ABOUT WHAT YOU ARE TOUCHING)

·         Open the packet and assemble the speculum

o   Check it works

o   Apply a drop of lubricant to both sides but not the tip and spread with finger

·         Ask the chaperone to turn on the light

·         “Alright Mrs Jones, please could you bring your heels towards your bottom and let your knees flop out to either side”

o   “I’m just going to have a look before I do anything”

o   Inspect for signs of infection, genital warts etc

o   “Ok, I’m going to do the smear test now”

·         Part the labia with left thumb and index finger

·         With speculum horizontal, slowly insert towards the small of the back

·         When the lever reaches the inner thigh, turn so the mechanism is pointing upwards

·         When all the way in, turn left hand so that the thumb is in position to open the lever

·         With right thumb holding the base firmly in place, slowly open the speculum

o   Look inside as you do

o   When you can see the os, fix the speculum with the nut

§  If you cannot see the os, ask the patient:

·         “Mrs Jones may I ask you to put your hands under your bottom for me?”

§  Gently rotate speculum if necessary

·         Take cells

o   Insert the central bristles of the brush into the os and rotate clockwise five times

o   Push the brush to the bottom of the vial 10 times and swirl vigorously

§  Inspect brush to ensure no material is left

§  Throw the brush away

§  Ask chaperone to put lid on the vial, otherwise wait until the end to do so with non-gloved hands

·         Make sure the black lines are aligned

·         Remove speculum

o   Release nut while holding speculum open with left hand

o   Retract slowly until the blades are clear of the cervix

o   Let go of the speculum completely with the left hand and slowly remove the speculum with right hand

o   Dispose of speculum

·         “Alright Mrs Jones, I’ve finished the smear test, is it alright for me to do the manual examination now?”

3.       Bimanual exam

·         Apply a little gel to the index and middle fingers of the right hand

·         Part labia with left hand and insert the two fingers into the vagina, towards the small of the back, turning as they go in

·         Feel for the cervix

o   Try to get your fingertips underneath it into the posterior fornix

o   Push the cervix up with a steady pressure

·         “May I ask you to uncover your tummy please?”

·         Start at the umbilicus and press firmly down towards the pubic bone

o   Move down in increments until you feel the cervix moving onto your inside fingers

§  Assess the uterus for:

·         Size

·         Mobility

·         Pain

·         Position

§  Palpate the right adnexa

·         Place fingers in right lateral fornix

·         With outside hand press down the inside of the hip bone and work down in increments

·         Do the same for the left

§  Withdraw fingers and examine for blood

§  Remove gloves away from the patient

·         “Alright Mrs Jones that’s all finished”

o   Deal with vial if necessary

·         “Here’s some tissue to wipe away the gel, just pop them in the yellow bin when you’re done”

·         “I’ll let you get dressed in privacy, I’ll just wash my hands, and you let me know when you’re ready”

Clear trolley

Explanation of results:

·         “Alright, was that okay?”

·         “The smear test results will come in the post in about 2 weeks, and I’ll get a copy, as well as your GP”

·         “The vast majority of these tests are completely normal so there’s no need to worry in the mean time”

·         “In the examination everything felt healthy and normal, and sometimes there’s a little blood after a smear test. It shouldn’t be prolonged or painful, but if you have any worries then you can see your GP”

·         “Do you have any other questions for me?”

·         “Thank you for coming”