25. The female genitalia

This chapter describes the gynaecological examination. We first briefly consider the anatomy of the female genitalia, with special reference to the changes that the female genital tract undergoes during various life stages. We then describe the various elements of gynaecological examination – external inspection, speculum examination and bimanual examination – mentioning important points to consider when carrying them out. Attention should be paid to how you communicate with the patient, and you should treat them with respect. After describing the technique required for each particular skill, we discuss possible clinical findings and their significance. Various tests on indication (e.g. vaginal discharge and cervical smear tests) are also dealt with, and the role of ultrasound scanning in gynaecological consultations is briefly considered. The chapter concludes with a summary of the evidence available on gynaecological examination in the literature, and a summary of the entire examination.