6122021 Per Vaginal Examinationi PV 6122021 Prepared by

6/12/2021

Per Vaginal Examination(i. PV) 6/12/2021

Prepared by Safaa ashry elsaid Clinical instructor of Obstetrics & Gynecology department Faculty of Nursing south valley University 6/12/2021

• • Introduction Wash your hands Introduce yourself Confirm the patient’s details (name/date of birth) Explain the examination and gain consent 6/12/2021

• Explanation Describe the examination Assess the patient’s current understanding of the examination: “Today I need to carry out a vaginal examination. Do you understand what the examination involves? ”

Provide a detailed explanation of the examination: • “What the examination will involve is me using my hand to place two fingers into your vagina. This will allow me to assess the vagina. It shouldn’t be painful, but it will feel a little uncomfortable. You will be in full control throughout the examination and you can ask me to stop at any point. ” . 6/12/2021

Gather equipment: Gloves Lubricant Paper towels 6/12/2021

Position The patient should be positioned supine on a bed with their underwear removed and their abdomen exposed (a modesty cloth should be provided): 6/12/2021

Class III : Moderate to marked limitation of physical activity. Excessive fatigue, dyspnea , palpitation or angina pain occurring less than Class with ordinary activity IV : Inability to carry on any physical activity. Dyspnea at rest. 6/12/2021

Vulval inspection 1. Don gloves 2. Inspect the vulva: Ulcers (e. g. genital herpes) Abnormal vaginal discharge (e. g. chlamydia or gonorrhoea) Scars from previous surgery (e. g. episiotomy) Vaginal atrophy (secondary to post-menopausal changes) 6/12/2021

. Masses (e. g. Bartholin’s cyst) Varicosities (varicose veins secondary to venous disease/obstruction in the pelvis) 3. Inspect for evidence of vaginal prolapse (a bulge visible protruding from the vagina). Asking the patient to cough as you inspect can exacerbate the lump and help confirm the presence of prolapse. 6/12/2021

Vaginal examination Warn the patient you are going to examine the vagina and ask if they’re still happy for you to do so. Entering the vagina 1. Lubricate the gloved index and middle fingers on your dominant hand 2. Carefully separate the labia using the thumb and index finger of your non-dominant hand 3. Gently insert the gloved index and middle finger of your dominant hand into the vagina 4. Enter the vagina with your palm facing laterally and then rotate 90 degrees so that it is facing upwards 6/12/2021

• • • Assess the cervix Position Consistency (hard/soft) Os (open/closed) Cervical excitation – severe pain on palpation of the cervix (may suggest pelvic inflammatory disease)

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Assess the fornices Gently palpate the fornices either side of the cervix for any masses. ﻷﻢ 6/12/2021

. To complete the examination… Withdraw your fingers – inspect the glove for blood or abnormal discharge Re-cover the patient – allow the patient time to re-dress in private 6/12/2021

Thank the patient Dispose of equipment into a clinical waste bin Wash hands 6/12/2021

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