Gynecological Examination

A gynecological assessment is not synonymous with an internal pelvic examination. For an asymptomatic, non-pregnant patient at average risk, routine speculum and bimanual examinations have not been shown to improve screening for ovarian cancer, bacterial vaginosis, trichomoniasis, or genital herpes. Perform an internal examination when symptoms, examination history, follow-up needs, or shared decision-making make it useful. The examination itself is not a cervical cancer screening test. Cervical screening is an interval-based program using cytology or HPV testing; repeating a Pap test at every gynecological visit is neither necessary nor appropriate. The clinician should be able to answer three questions before beginning: 1. What problem is being assessed? 2. Which part of the examination can answer that question? 3. What finding would change the urgency or next step? The assessment may include abdominal and external inspection alone. A speculum examination is needed to visualize the vagina and cervix or collect certain specimens. A bimanual examination assesses cervical motion, uterine characteristics, and adnexal tenderness or masses. A rectovaginal examination is reserved for a specific indication and requires separate consent. Normal findings vary...