Davao Medical School Foundation, Inc.

Arts and Science of Medicine 2

RATING SCALE FOR THE GYNECOLOGIC EXAM

NAME : ________________________________________________________ GRADE _________________

INSTRUCTION TO PRECEPTORS :
Rate the student by writing the number that corresponds to the equivalent skill performed for
each step.

STEPS TO PERFORM NAME OF STUDENTS

A. Establish patient rapport

1. Greets patient and introduces self
2. Obtains permission and selects chaperone (or gets a
female companion if examiner is male. )
3. Explains each step of the
examination in advance.
4. Drapes the patient from midabdomen to knees; depresses
the drape between the knees to provide eye contact with
patient.
5. Avoids unexpected or sudden
movements.
B. External Examination
1. Seats self comfortably and informs patient about
procedure ie. touching her genital area;
2. Assesses Sexual Maturity : pubic hair characteristics and
distribution ( if examining an adolescent.)
(Tanner staging)
3. Inspects : mons pubis,
labia and perineum
4. Separates labia and inspects : labia minora, clitoris,
urethral meatus, introitus. (notes presence of
inflammation, ulceration, discharge, swelling or nodules.)
5. Inserts index finger into vagina near posterior introitus,
palpates each side between finger and thumb (4 & 8
o’clock positions) checks swelling or tenderness &/or
discharges exuding from duct opening of gland.
eg. Bartholins gland

B. Internal Examination
1. Selects appropriate speculum size and moistens it with
warm water.
2. Informs patient that speculum will be inserted.
3. Moistens one finger with water and applies downward
pressure at lower margin of introitus; palpates location of
cervix for proper angulation of speculum.
4. With the other hand, introduces the close speculum
(usually left hand) while separating labia majora with right
hand to avoid pinching of labia or pulling on pubic hair.
5. Slides speculum inward along the posterior wall of the
vagina applying downward pressure to keep vaginal
introitus relaxed. Removes finger of other hand
from vagina after speculum has been inserted.
6. Rotates speculum in a
horizontal position (maintaining pressure posteriorly); and
inserts it to its full length,
without prematurely opening blades of speculum
7. Inspection of cervix :
Opens speculum carefully; rotates and adjust until
speculum cups the cervix bringing it into full view; fixes
speculum by tightening thumbscrew.
Positions light to see cervix well.
a. Wipes discharge gently away from cervix with a large
cotton swab
b. Notes color of cervix, position, surface characteristics;
ulcerations, nodules, masses, bleeding or discharge.
c. Inspects cervix for discharge.
d. Obtains specimen for cervical cytology.
8. Inspection of Vagina
a. Withdraws speculum slowly while observing vaginal
walls.
Notes color, and presence of inflammation, discharge,
ulcers or masses.
b. Releases thumbscrew and maintains open position of
speculum with thumb.
c. Closes speculum as it emerges from introitus.
9. Bimanual Examination
a. Lubricates index and middle fingers of one of gloved
hands;
b. From a standing position, inserts lubricated fingers into
vagina, exerting pressure posteriorly with thumb
abducted and little fingers flexed into
palm.
Notes any nodularity and tenderness in vaginal wall
including region of urethra and bladder anteriorly.
c. Palpates cervix for position, shape, consistency,
regularity, mobility and tenderness and feels fornices
around cervix.
d. Palpates uterus with other hand on abdomen midway
between umbilicus and symphysis pubis.
e. Elevates uterus and cervix with pelvic hand, pressing
abdominal hand in and down trying to grasps uterus
between hands. Notes size, shape, consistency, and
mobility, identifying tenderness and masses.
f. Slides fingers of pelvic hands into anterior fornix and
palpate body of uterus between hands.
g.Palpates each ovary by placing abdominal hand on right
lower quadrant and pelvic hand on right lateral fornix;
 g. Presses abdominal hand in and down pushing adnexal
structures toward pelvic hand;
h. Identifies right ovary or any masses;
i. Repeat procedure on left side.
Points : 30 points

10. Assessment of pelvic floor

muscles for strength and tenderness.
After bimanual examination, withdraws examining fingers
from cervix and spreads them against vaginal walls.
a. Asks patient to squeeze around fingers; checks for
strength, tenderness and appropriate relaxation after
contraction and endurance in all 4 quadrants.
b. With fingers placed posteriorly, asks patient to cough
several times or bear down, looking for any urinary
leakage and watching for tightening of adductor or
gluteal muscles.
c. Palpates external pelvic floor muscles in a clockwise
rotation to identify trigger points (tenderness).
d. Performs rectovaginal exam if indicated. (1 pt)
Computation : (IMD)total points earned/ total number of items x 60 + 40 = _________________
(individual grade)

Computation : (IMD)total points earned/ total number of items x 50 + 50 = _________________

(individual grade)