What are the typical steps of a pelvic examination, in order?

What are the typical steps of a pelvic examination, in order?

• A. Start with rectal exam
• B. Inspect external genitalia, perform a speculum exam to visualize cervix and vaginal mucosa, then perform a bimanual (and rectovaginal if indicated) exam
• C. Use ultrasound first
• D. Inspect only

Answer: (B)

In a pelvic examination, the steps follow a logical sequence that builds from external visualization to internal assessment. Start by inspecting the external genitalia for signs of infection, lesions, discharge, or inflammation. This initial check helps identify obvious problems and guides the rest of the exam. Next, perform a speculum exam to visualize the vaginal walls and the cervix, allowing assessment of mucosa, discharge, lesions, the cervical transformation zone, and cervical bleed risk. After the cervix and vagina have been inspected, proceed with a bimanual exam to feel the uterus and adnexa from the inside: you assess size, position, mobility, tenderness, and detect any masses. If indicated by symptoms or findings, a rectovaginal exam is added to further evaluate the posterior pelvic structures and cul-de-sac. Ultrasound may be used if imaging is warranted, but it is not part of the standard stepwise physical exam. Inspecting only would miss critical findings visible on exam, and starting with imaging or a rectal exam before completing the initial inspection and speculum exam would overlook essential clinical details.

In a pelvic examination, the steps follow a logical sequence that builds from external visualization to internal assessment. Start by inspecting the external genitalia for signs of infection, lesions, discharge, or inflammation. This initial check helps identify obvious problems and guides the rest of the exam. Next, perform a speculum exam to visualize the vaginal walls and the cervix, allowing assessment of mucosa, discharge, lesions, the cervical transformation zone, and cervical bleed risk. After the cervix and vagina have been inspected, proceed with a bimanual exam to feel the uterus and adnexa from the inside: you assess size, position, mobility, tenderness, and detect any masses. If indicated by symptoms or findings, a rectovaginal exam is added to further evaluate the posterior pelvic structures and cul-de-sac. Ultrasound may be used if imaging is warranted, but it is not part of the standard stepwise physical exam. Inspecting only would miss critical findings visible on exam, and starting with imaging or a rectal exam before completing the initial inspection and speculum exam would overlook essential clinical details.