Bimanual Examination

University:
Western Sydney University
Course:
MEDI 2003 | Clinical Sciences 2
Academic year:

2024
Views:

179

Pages:

4
Author:

Mariam A. A.

Bimanual Examination Basic Info Used to examine the uterus, cervix, ovaries and adnexa (ovaries and fallopian tubes) Assess size, shape, position and mobility of the uterus. Detects masses, tenderness or irregularities in the adnexa. Evaluate cervical motion tenderness Involves inserting two gloved lubricants Usually down after CST not before, as in BM we use lubricant so if wedp CST after all the will be picked up is the lubricant Abdominal exam Always do this prior Inspection and palpation. Vulval examination Do prior to bimanual Palpate inguinal lymph nodes Acute infections e.g. herpes, STIs e.g. chlamydia Malignancy e.g. vulval cancer In inspection look for: Ulcers Abnormal vaginal discharge Scarring Vulvovaginal atrophy Leucoplakia Masses Varicosities FMG Look for: Vaginal prolapse Ask the patient to cough Exacerbates the lump Confirmation of prolapse Vaginal Examination Lubricate Separate the labia using thumb and index finger of dominant hand Palm facing laterally Insert middle and index finger into the vaginal introitus while applying pressure to the rectum (all with the same hand) Fingers go along the posterior vaginal wall Should be free and mobile – in rocking If firm and immobile -> endometriosis If free and mobile -> pathology in FT or uterus This is the only time that the internal hands do moving The entire other time it is the external hand that is doing the work When do we feel the uertus in the different position like when antroverted or retoverted A retroverted utertus is more difficult to palpate Place the other hand on the woman’s abdomen above the pubic symphysis: Vagina: Vaginal walls -> masses and irregularities Vaginal fornixes Superior portion of vagina Masses Cervix Position -> anterior or posterior Consistency -> irregularities, smooth Place the other hand on the suprapubic region of the abdomen With the two fingers move in all four directions -> pain? -> PID Uterus The non-dominant hand on the suprapubic region With the examining hand -> push upwards while palpating the lower abdomen -> should feel uterus move between hands. Assess for: Size Shape Surface characteristics Tenderness Position Usually, preaxial or anteverted In some may be postaxial or retroverted in 10% of females. Feel the pouch of Douglas for any thickening or nodules -> endometriosis Ovaries and fallopian tubes Position fingers in the right lateral vaginal fornix Non-dominant hand on the right iliac fossa Do deep palpation of the right iliac fossa Normal not to feel it If cant feel it-> normal But do not tell woman that you cannot feel it because she will panic Of of trying to see if there is pain or masses Assess for: Masses -> evaluate size, shape, consistency and tenderness Do the same but for the left Legal obligations The person performing the exam is responsible for: Ensuring the woman receives her results Making an appropriate follow up If the woman does not show up for a repeat you are responsible to organise another one for her.