Pelvic Examination

  1. Perform hand hygiene and apply gloves.
  2. Verify patient's identity in accordance with institutional policy.
  3. Stay at the side of the patient while the advanced practice nurse or the physician performs the exam.
  4. Ensure that the patient is forewarned that she will feel her inner thigh being touched and then the examiner will inspect the external genitalia.
  5. Supply the physician or advanced practice nurse with warm water or lubricant to moisten the speculum. Warm water should be used on the speculum instead of lubricant if cultures or other specimens are to be obtained.
  6. The physician or advanced practice nurse first inserts one or two fingers into the introitus and then inserts a moistened, appropriately sized speculum. Then the speculum is opened and locked into place. If a plastic speculum is used, advise the patient that she will hear a clicking noise when the speculum is locked.
  7. As requested, give the examiner a long swab stick or dry gauze dressing held by ring forceps. The examiner then inspects the cervix.
  8. Assist with specimen collection and transport as specified by the laboratory. These may include one or more of the following:
  9. Papanicolaou smear, which must be performed before any other specimen is obtained or lubricant is used
  10. Gonorrhea
  11. Chlamydia
  12. Gram's stain
  13. Potassium hydroxide (KOH) slide to look for Candida (yeast) organisms
  14. Wet mount (normal saline solution) to look for trichomonas or clue cells for bacterial vaginosis
  15. When the speculum exam is completed, the speculum is withdrawn, and a bimanual examination is performed. Next, the physician or advanced practice nurse changes gloves, adds lubricant, and performs a rectovaginal examination.
  16. Assist the patient in removing her feet from the stirrups. Offer her a damp washcloth and towel with which to cleanse herself after the examination.
  17. Discard supplies, remove gloves, and perform hand hygiene.
  18. Document the procedure in the patient's record.