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.