Synopsis
Choose, prepare and perform speculum or bimanual examination only when it answers a defined clinical question, using consent-led technique and interpreting findings within the examination’s important limitations.
- Do not perform an intimate examination ceremonially: state whether the question concerns vulval disease, bleeding source, cervix, discharge, prolapse, uterine size, tenderness or an adnexal mass.
- Explain inspection, speculum and bimanual components separately, offer a trained chaperone, provide privacy and agree a stop signal before positioning or exposure.
- Choose a comfortable position and the smallest suitable instrument, warm it, use a small amount of compatible lubricant, and consider patient self-insertion when preferred and clinically feasible.
Key red flags
Pain, bleeding, syncope or shoulder-tip pain with a positive or uncertain pregnancy test can represent ectopic pregnancy even if pelvic findings are mild.
An irregular, ulcerated, friable or bleeding cervical lesion requires urgent specialist assessment regardless of a previous normal screening result.
Investigation priorities
Identify vulval, urethral, traumatic, dermatological or prolapse findings relevant to the complaint.
Management branches
New symptoms might justify a focused pelvic examination.
- Establish pregnancy possibility, physiological risk and leading mechanisms, then ask whether inspection, speculum or bimanual findings will change immediate management.
- Offer less intrusive alternatives when they answer the same question and explain any diagnostic uncertainty if examination is declined.