What are the components of a gynecologic/pelvic exam including the order and what is assessed?

• A. External genitalia inspection only.
• B. External genitalia inspection; speculum exam to visualize vagina and cervix; bimanual/pelvic exam to assess uterus, ovaries, adnexa, and pelvic floor; check cervical motion tenderness and masses; maintain sterile technique and patient comfort.
• C. Use only ultrasound.
• D. No internal exam.

Answer: (B)

A complete gynecologic/pelvic exam follows a stepwise, systematic approach: start with inspection of the external genitalia, then visualize the vagina and cervix with a speculum, and finally assess the internal organs with a two‑handed (bimanual) examination. Each step builds on what you can detect about anatomy and possible pathology.

External genitalia inspection looks for skin changes, lesions, discharge, swelling, or asymmetry, which can point to infections, dermatologic issues, or trauma.

During the speculum exam you visualize the vaginal walls and the cervix. You assess the mucosa for color and friability, observe any discharge or lesions, note the appearance and position of the cervix, and examine the cervical os. This step may include obtaining samples for a Pap smear, gonorrhea/chlamydia testing, or cultures if indicated, and you evaluate for any polyps or masses.

The bimanual examination involves placing one hand inside the vagina and gently pressing with the other hand on the abdomen to feel the uterus, ovaries, and adnexa. You determine the uterus’s size, contour, mobility, and orientation; palpate for tenderness, fibroids, or an enlarged uterus; assess the ovaries and adnexa for masses or tenderness; and evaluate pelvic floor tone and support. You also check for cervical motion tenderness, which can suggest inflammatory or infectious processes.

Throughout, keep sterile technique and prioritize patient comfort and privacy. If imaging like ultrasound is indicated or if a rectovaginal exam is needed in certain circumstances, these are adjuncts rather than replacements for the standard sequence and findings described.