Pelvic Examination

The pelvic exam traditionally includes an examination of the external and internal genitalia. Under some conditions, it may be necessary to perform a rectal examination as well. A gynecological exam is typically needed for females with gynecological complaints or for screening for cervical cytology at 21 years of age. Relevant anatomy includes the external and internal anatomy. The external genitalia, or vulva, include the mons pubis, labia majora and minora, the clitoris vestibular bulbs, vulvar vestibule, Skene’s and Bartholin glands, urethral meatus, and the vaginal opening. The mons pubis is a rounded area of fatty tissue overlying the pubic symphysis. The 2 cutaneous folds that work posteriorly from the mons pubis are the labia majora. The clitoris is a small projection of erectile tissue located at the anterior end of the labia majora. Typically, there is a flap of skin overlying the clitoris known as the clitoral hood. From the clitoris extending posteriorly are 2 inner cutaneous folds called the labia minora, which often vary widely in shape, color, and size. The perineum is the area located posterior to the labia majora extending to the anus. The almond-shaped area encompassed by the labia minora is termed the vestibule. The vestibular bulbs are 2 elongated masses of erectile tissue that are joined together by a narrow band anteriorly and partially extend laterally around the vaginal opening. The urinary meatus can be found just anterior to the vaginal opening in the vestibule and typically takes the shape of a sagittal cleft. The Skene’s glands are located to either side of the urinary meatus within the vestibule. The Bartholin glands are found at 4 o’clock and 8 o’clock positions in the vestibule. The internal genitalia encompasses the vagina, cervix, fornix, as well as the uterus, fallopian tubes, and ovaries. The vagina is a muscular, elastic canal that extends from the vulva to the protrusion of the cervix. The part of the vagina which surrounds the cervix is the fornix and can be described as anterior, posterior or lateral to the cervix. The hymen is a membrane of tissue that covers or partially covers the vaginal opening, typically crescentic. There are many variations to the shape of the hymen, and it may disappear completely after intercourse, masturbation, pelvic examination, disease, injury or physical exercise. Without arousal, the vaginal canal is generally 3 inches long. The cervix is a once inch cylindrical structure that bulges into the vagina with a narrow cervical canal running its entire length which connects the vaginal canal to the uterus. The cervical opening on the vaginal side is called the external os and the opening on the uterine side is called the internal os. The uterus is a triangular shaped muscular organ typically about three inches long in a nongravid woman. The uterine cavity opens into two fallopian tubes bilaterally which overly the ovaries on either side of the uterus. Credit: Bialy A, Wray AA. Gynecologic Examination. [Updated 2022 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Assisting with a Pelvic Examination and Pap Test: /watch/IC4qTzcsIlSsq pressfoto @ freepik.com

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