PER SPECULUM (PS) & PER VAGINAL (PV) EXAMINATION

The Per Speculum (PS) & Per Vaginal (PV) Examination – I course is a structured, competency-oriented clinical skills module designed to introduce undergraduate MBBS students to the principles and technique of pelvic examination in Obstetrics & Gynaecology.

The course uses a simulation-based approach to help students develop familiarity and confidence with the instruments, examination sequence, patient preparation, communication, positioning and systematic assessment of pelvic structures before progressing to appropriately supervised clinical encounters.

Particular emphasis is placed on the fact that PS and PV examination are intimate clinical examinations. Therefore, technical proficiency must always be accompanied by informed consent, respectful communication, privacy, dignity, appropriate chaperone practice, infection prevention and attention to patient comfort.

Students are introduced to the systematic approach to visual examination of the vagina and cervix using a vaginal speculum, followed by the principles of digital and bimanual PV examination, including assessment of the cervix, uterus and adnexa where clinically indicated.

Course Learning Outcomes

By the end of the course, the learner should be able to:

Knowledge

1. Define Per Speculum and Per Vaginal examination.

2. Explain the clinical purpose and indications of PS and PV examination.

3. Describe the relevant pelvic anatomy.

4. Identify commonly used vaginal specula and their basic uses.

5. Describe important precautions and contraindications.

6. Recognize important normal and abnormal examination findings.

Clinical Skills

7. Prepare the patient and examination environment appropriately.

8. Demonstrate appropriate consent, communication and chaperone practice.

9. Position the patient correctly while maintaining privacy and dignity.

10. Perform systematic external inspection.

11. Demonstrate safe handling and insertion of a vaginal speculum on a pelvic simulator.

12. Systematically inspect the vaginal walls and cervix.

13. Demonstrate the principles of digital PV examination on an appropriate simulator.

14. Assess the cervix, uterus and adnexal regions systematically where indicated.

15. Identify and communicate relevant examination findings.

16. Document findings accurately and systematically.

Professionalism

17. Demonstrate respect for patient autonomy and the right to refuse examination.

18. Maintain confidentiality, privacy and dignity throughout the procedure.

19. Recognize and respond appropriately to pain, discomfort or distress.

20. Apply infection-prevention and safe-practice principles.

Course Content

The course is organized into progressive learning modules.

Module 1 — Introduction and Orientation

Students are introduced to:

• Purpose of the examination

• Role of PS and PV examination in clinical practice

• Relevant pelvic anatomy

• Examination sequence

• Simulation-based learning environment

• Expected professional behaviour

Module 2 — Consent, Communication, Privacy & Chaperone

Students learn how to:

• Introduce themselves

• Confirm patient identity

• Explain the examination in understandable language

• Obtain informed consent

• Explain what the patient may experience

• Offer/arrange an appropriate chaperone

• Maintain privacy and dignity

• Obtain permission before proceeding

• Recognize withdrawal of consent

• Respond appropriately to patient discomfort or anxiety

Key principle: Consent is an ongoing process and may be withdrawn at any time.

Module 3 — Equipment and Preparation

Students become familiar with:

• Examination couch

• Adequate examination light

• Cusco's speculum

• Sims' speculum

• Gloves and appropriate PPE

• Water-based lubricant where appropriate

• Gauze/swabs

• Specimen containers where indicated

• Kidney tray

• Drapes

• Waste-disposal facilities

• Pelvic examination simulator

Students also learn appropriate preparation, handling and disposal/reprocessing of equipment according to institutional infection-control policy.

Module 4 — Patient Preparation, Positioning & External Examination

The learner is taught to:

• Explain the next steps before proceeding

• Provide adequate privacy

• Ensure appropriate draping

• Position the patient correctly

• Maintain patient comfort

• Perform systematic external inspection

• Recognize obvious external abnormalities requiring further evaluation

Simulation is used extensively during this stage to allow repeated practice without compromising patient dignity.

Module 5 — Per Speculum Examination

Students learn the systematic principles of:

1. Selecting and checking the appropriate speculum.

2. Handling the instrument safely.

3. Maintaining appropriate communication.

4. Introducing the speculum gently.

5. Avoiding unnecessary force.

6. Visualizing the cervix.

7. Inspecting the vaginal walls.

8. Assessing the cervix systematically.

9. Recognizing discharge, bleeding, lesions, ulceration, growths and other abnormalities.

10. Safely removing the speculum.

11. Ensuring patient comfort after completion.

Module 6 — Per Vaginal Examination

Students are introduced to the principles of digital and bimanual examination, including assessment of:

Cervix

• Position

• Consistency

• Mobility

• Tenderness

• Other relevant findings

Uterus

• Size

• Position

• Mobility

• Consistency

• Tenderness

Adnexa / Pelvis

• Tenderness

• Masses or fullness where appreciable

• Other clinically relevant abnormalities

The examination should always be performed only when clinically appropriate, consented to and under the level of supervision required for the learner.