Temperature
Abdominal examination
Vulval, vaginal and cervical examination
Screening for STIs
Microscopy to identify gonorrhoea, BV,
trichomonas, fungal infections or inflammation
(pus cells)
Bimanual examination (BME)
The exclusion of an ectopic pregnancy is an
essential step in every sexually active patient who
presents with lower abdominal pain, regardless of their
current contraceptive method. An ectopic pregnancy
is a medical emergency and the patient should
immediately be referred to gynaecology.
This article assumes that nurses undertaking the
examination are working within a field relating to
sexual health and consequently will not detail what
is specifically required for abdominal, vaginal and
bimanual examinations. Further guidance on this
can be found in the ‘Genital examination in women’
(RCN, 2013). The need for a bimanual examination
(BME) varies across different departments and
specialities; within genito-urinary medicine the main
purpose is to assist in the diagnosis of PID (or fit
contraception coils). Local guidelines will determine
the scope of practice of practitioners and what training
requirements are needed to obtain this skill. A BME
involves a systematic approach to examining the
vagina, cervix, uterus and adnexa with the fingers
of one hand inside the vagina while using the other
hand to examine the lower abdomen. Abnormal
lumps, tenderness and masses should be identified and
considered when making a diagnosis.
Should the patient report pain or tenderness
during cervical motion or in the adnexa, this can
potentially indicate PID. Before a diagnosis can be
made it is essential to consider the full history and
clinical findings before making a diagnosis. There
are other conditions that should also be considered
or ruled out before making a diagnosis, as detailed in
Table 1.
Diagnosis
If there is any indication of a severe infection further
advice should always be sought from a senior
doctor who is equipped to manage the infection.
Serious infections may need hospitalization for
intravenous therapy or intensive monitoring. All
pregnant patients with signs or symptoms of PID
should be discussed with an appropriately qualified
staff member to ensure the patient does not have an
ectopic pregnancy.
TemperatureAbdominal examinationVulval, vaginal and cervical examination Screening for STIsMicroscopy to identify gonorrhoea, BV,trichomonas, fungal infections or inflammation(pus cells)Bimanual examination (BME)The exclusion of an ectopic pregnancy is anessential step in every sexually active patient whopresents with lower abdominal pain, regardless of theircurrent contraceptive method. An ectopic pregnancyis a medical emergency and the patient shouldimmediately be referred to gynaecology.This article assumes that nurses undertaking theexamination are working within a field relating tosexual health and consequently will not detail whatis specifically required for abdominal, vaginal andbimanual examinations. Further guidance on thiscan be found in the ‘Genital examination in women’(RCN, 2013). The need for a bimanual examination(BME) varies across different departments andspecialities; within genito-urinary medicine the mainpurpose is to assist in the diagnosis of PID (or fitcontraception coils). Local guidelines will determinethe scope of practice of practitioners and what trainingrequirements are needed to obtain this skill. A BMEinvolves a systematic approach to examining thevagina, cervix, uterus and adnexa with the fingersof one hand inside the vagina while using the otherhand to examine the lower abdomen. Abnormallumps, tenderness and masses should be identified andconsidered when making a diagnosis.Should the patient report pain or tendernessduring cervical motion or in the adnexa, this canpotentially indicate PID. Before a diagnosis can bemade it is essential to consider the full history andclinical findings before making a diagnosis. Thereare other conditions that should also be consideredor ruled out before making a diagnosis, as detailed inTable 1.DiagnosisIf there is any indication of a severe infection furtheradvice should always be sought from a seniordoctor who is equipped to manage the infection.Serious infections may need hospitalization forintravenous therapy or intensive monitoring. Allpregnant patients with signs or symptoms of PIDshould be discussed with an appropriately qualifiedstaff member to ensure the patient does not have anectopic pregnancy.
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