Bimanual (Vaginal) Exam

Introduces self	0	1
Confirms name & age of patient	0	1
Explains & gains consent	0	1
Asks patient to empty bladder before commencing examination and also if they require a smear (this should be done before bimanual exam)	0	1
Informs patient that a chaperone will be present	0	1
Informs the patient that it is possible to lock the room to maintain privacy	0	1
Asks patient to undress behind the curtain from the waist down and lie flat on the couch covering themselves with a towel	0	1
Collect equipment (gloves, lubricant)	0	1
Washes hands	0	1
Expose patient and ask them to bend their knees, bringing their feet to their bottom and let their knees drop either side	0	1
Inspect the external genitalia for any discharge, scars, cysts, irritation, proplapse or any other abnormalities	0	1
Ask the patient if they have any pain and inform the patient that you are about to begin the examination and that they can tell you to stop at any time	0	1
Applies lubricant to two gloved fingers. Introduces fingers with palm facing towards the patient’s right if using your right hand	0	1
Palpates the vaginal wall for tenderness and masses	0	1
Palpates the cervix feeling for any masses or tenderness (excitation). Comment on the surface, consistency and mobility (should be like tip of nose)	0	1
Palpate the abdomen to identify the top of the uterus whilst pushing it anteriorly from inside. Comment on the size and whether the uterus is anteverted or retroverted (in the latter you need to feel palpate deeper on the abdomen). Feel for any masses and the mobility of the uterus as well as for tenderness	0	1	2
Palpate the adenexae. With your gloved fingers, feel either side of the cervix as deep as possible whilst with your palpating hand, roll the iliac fossa towards your hand. Attempt to catch the ovaries which should normally be impalable	0	1
Remove your gloved fingers and with your back to the patient, inspect your fingers for blood or discharge	0	1
Allow the patient privacy and tissues to clean the area and redress	0	1
Dispose of all waste in the appropriate bin	0	1
Summarises appropriately with only key findings	0	1
Offers appropriate differential diagnoses if any abnormalities noted and explains these to patient	0	1
Offers next steps according to guidelines (e.g. pre-eclampsia: senior review, whether to admit patient and give antihypertensives and whether to deliver baby)	0	1
Patient global score	0	1	2

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