PS (Per Speculum) Examination

Position & Preparation

• Patient: Dorsal lithotomy position
• Bladder khali karwao
• Chaperone present karo
• Gloves pehno, patient ko inform karo

Steps (Step-wise)

Step 1 - External Inspection (Vulva)

• Labia majora/minora
• Clitoris, urethral meatus
• Perineum, perianal area
• Koi lesion, erythema, discharge, trauma, ulcer, wart

Step 2 - Separate Labia

• Labia majora ko spread karo
• Introitus dekho - lesion, discharge, blood?
• Bartholin gland area check karo (posterior fourchette)

Step 3 - Speculum Insert Karo

• Speculum choose karo (Pederson - nulliparous, Graves - parous/lax walls)
• Warm karo speculum pehle
• Lubricate (water only if Pap smear lena hai)
• Patient se kehna - thigh muscles relax karo
• Labial spreading karke speculum poori length tak insert karo
• Open the speculum

Step 4 - Cervix Inspect Karo

• Position (anterior/posterior)
• Size & shape - normal/abnormal
• Os - circular (nulliparous) / transverse slit (parous)
• Colour - pale pink (normal), bluish (Chadwick's sign in pregnancy)
• Discharge - colour, consistency, smell
• Squamocolumnar junction (SCJ) - erosion? lesion? white patch? (condyloma, CIN?)
• Bleeding - contact bleeding?
• Nabothian cysts, polyps, growth

Step 5 - Swabs/Samples Lena (if needed)

• High Vaginal Swab (HVS)
• Endocervical swab (STD screen)
• Pap smear / cervical cytology
• pH paper (vaginitis)

Step 6 - Vaginal Walls Inspect Karo

• Speculum slowly withdraw karte waqt vaginal walls dekho
• Discharge, lesions, prolapse, rugae
• Introitus se nikalne se pehle speculum band karo

Doctor Short Note (PS format)

PS: Vulva - NAD. Speculum inserted - cervix well visualized.
Cervix: Parous os, pink, healthy. No discharge/bleeding/lesion seen.
SCJ visible, no erosion. Vaginal walls - NAD.
Swabs sent. Speculum removed.

PV (Per Vaginum / Bimanual) Examination

Steps

Step 1 - Preparation

• Gloves, lubricant apply karo
• Patient ko inform karo
• Index finger (nullip) ya index + middle (parous) insert karo

Step 2 - Palpate Labia & Introitus

• Labia majora palpate karo
• Introitus inspect karo

Step 3 - Cervix Palpate Karo

• Position - anterior/central/posterior
• Consistency - soft (pregnancy/normal)? firm? hard?
• Os - open/closed?
• Cervical motion tenderness (CMT) - PID mein hota hai
• Side to side movement pain = CMT positive

Step 4 - Uterus Palpate Karo (Bimanual)

• Intravaginal fingers: posterior fornix mein place karo
• Abdominal hand: pubis ke upar raho
• Dono haath milake uterus ko feel karo

Step 5 - Adnexa Palpate Karo (Bilateral)

• Fingers ek side le jao cervix ke
• Abdominal hand us side place karo
• Adnexa ko feel karo between both hands

• Mass hai? - Size (3D), firmness, fixation, tenderness
• Normal ovary - almond size, slightly tender
• TOA, ectopic, fibroid, ovarian cyst - pathology

Step 6 - Forniceal Tenderness

• Anterior, posterior, lateral fornix mein tenderness?
• Posterior fornix fullness = collection/endometriosis/ectopic

Doctor Short Note (PV format)

PV: Vagina - normal rugae, no lesion.
Cervix: Central, firm, os closed, CMT absent.
Uterus: Anteverted, anteflexed, normal size, smooth, mobile, NT.
Adnexa: B/L - No mass/tenderness palpable.
Fornices: Free, non-tender.

Combined Short Note (Full Gynaec Exam)

Abdomen: Soft, non-tender, no palpable mass.
PS: Cervix - healthy, parous os. No discharge. Vaginal walls NAD.
PV: Uterus - anteverted, normal size, mobile, NT. B/L adnexa - free. 
CMT absent.

Abbreviations (Doctors likhte hain)