Gynecological Exam

The comprehensive gynecological examination is a foundational NP clinical skill requiring knowledge of female reproductive anatomy, hormonal physiology, and systematic examination techniques. The external genitalia (vulva) includes the mons pubis, labia majora, labia minora, clitoris, urethral meatus, vaginal introitus, Skene glands (paraurethral), and Bartholin glands (greater vestibular). The internal exam assesses the vaginal canal (rugae, discharge, lesions), cervix (position, shape, os appearance, discharge, lesions, cervical motion tenderness), uterus (size, shape, position — anteverted/retroverted, tenderness, masses), and adnexa (ovaries and fallopian tubes — size, tenderness, masses). The exam is guided by the menstrual cycle phase: proliferative (estrogen-dominant: thin, clear cervical mucus, proliferating endometrium), secretory (progesterone-dominant: thick mucus, glandular endometrium), and menstrual phase. Cervical screening follows USPSTF/ACS guidelines: Pap smear every 3 years (ages 21–29), Pap + HPV co-testing every 5 years or Pap alone every 3 years (ages 30–65), or primary HPV testing every 5 years (ages 25–65 per ACS 2020). The NP integrates screening guidelines, STI testing, contraceptive counseling, and recognition of pathology including cervicitis, vaginitis, cervical dysplasia, pelvic inflammatory disease, endometriosis, ovarian masses, and pelvic organ prolapse.