Vaginal Examination

A physical examination of the female pelvic organs is known as a pelvic exam, also referred to as a vaginal exam. The two sections are the external examination and the inside examination. A "Bimanual Exam" and a "Manual Uterine Palpation" are other names for it (palpation meaning an examination by touch). Gynecology frequently employs it. Performing a vaginal examination is a private procedure that should only be used when absolutely necessary and will provide data to help with decision-making (NICE, 2007). The examination should always be conducted with compassion and utmost respect for the client's dignity. The woman should be in a relaxed position, her bladder should be empty, and the inspection should be fully described by the midwife. Informed consent must be obtained before the procedure can be carried out.

Indications

• Verify the beginning of labor.
• Identify the appearance and position of the fetus.
• Analyze any delays or progress in the labor. Determine whether forewaters are present (and burst membranes if necessary).
• Evaluate before administering analgesia.
• Put a fetal scalp electrode to use (carry out fetal blood sampling).
• When the forewaters spontaneously rupture, rule out cord prolapse, especially if the presenting section is uncomfortable.
• Particularly in a breech presentation, confirm complete cervical dilation.

Procedure

• Talk to the woman while conducting the inspection.
• Keep her in a position that will preserve her dignity at all times.
• Washing hands is advised.
• Prepare the vaginal examination kit and the trolley.
• Grab a pair of gloves.
• It is best to swab the vulva from front to back.
• Use only the individual sterile lubricating gel.
• With your "dirty" hand, hold the labia apart while slowly advancing your "clean" fingers backward and downward into the vagina.

During Examination

• External visual exam 
  Your doctor will first perform a visual examination of your vulva to check for any abnormalities such as swelling, edema, sores, inflammation, or redness.
• Internal visual exam 
  Your doctor will then spread open your vaginal walls and use a speculum, a tool with a plastic or metal hinge resembling a duck's bill, to view your vagina and cervix. The speculum needs to be warmed up before being inserted.

           Some women may experience pain when the speculum is inserted and opened. Try to relax as much as you can             to reduce pain, but let your doctor know if it is severe.

• Pap test
  If your pelvic check includes a Pap test, your doctor takes a sample of your cervical cells before withdrawing the speculum (Pap smear).
• Bimanual exam
  Your doctor must palpate your belly and pelvis during this portion of the examination because your pelvic organs, including as your uterus and ovaries, cannot be seen from the outside. In order to do this, your doctor gently presses on the exterior of your lower abdomen with one hand while inserting two lubricated, gloved fingers into your vagina with the other.

Your doctor will check the size and shape of your uterus and ovaries during this portion of the examination, noting any sensitive areas or odd growths. Following the vaginal examination, your doctor will insert a gloved finger into your rectum to feel for pain, growths, or other abnormalities.

Findings

Examine the external genitalia for indications of

• Varicosities.
• Edema.
• Warts.
• Previous scarring.
• Mutilation and type.
• Discharge or bleeding.

The vagina should always be warm and moist during normal labor, but it can feel hot and dry during prolonged or obstructed labor. Once the probing fingers reach the end of the vagina, the delicate pads are angled upwards towards the cervix. Finding the os will be made easier by sliding your fingers side to side. Although it is usually in the middle, it may be in the back in the early stages of labor.

You're checking for

• Effacement.
• Virility of the cervix.
• Dilatation is measured from one to 10 times in millimeters.
• membranes present; if ruptured, the liquor should be clear and flavorless.
• the location and mode of the presenting component (identify any molding or caput that may be present).

After the procedure, the fetal heart should be auscultated, the woman should be positioned comfortably, and the findings should be discussed and recorded with her

.