📚🧕👩⚕️ Breast and Pelvis Examination
📘 Highly Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Midwifery, Obstetric, and Medical-Surgical Nursing Exams
✅ 1. Introduction / Definition:
Breast and pelvic examinations are essential parts of the clinical assessment in women’s health to detect abnormalities such as tumors, infections, reproductive issues, or anatomical deviations, and are especially important during antenatal care and gynecological assessments.
“Breast and pelvic exams are systematic physical assessments to evaluate the anatomical and physiological condition of female reproductive organs and breasts.”
🧕 PART A: Breast Examination
✅ 2. Purpose:
- Detect lumps, pain, discharge, or breast cancer
- Assess for pregnancy-related changes
- Educate patient on breast self-examination (BSE)
✅ 3. Procedure for Clinical Breast Examination:
🔹 Preparation:
- Ensure privacy and comfort
- Explain the procedure to the patient
- Perform in a well-lit room, preferably during first 10 days of menstrual cycle
🔹 Steps:
1. Inspection (Patient in sitting position):
- Observe for size, shape, symmetry
- Look for skin changes: dimpling, redness, puckering
- Inspect nipples: position, discharge, inversion
2. Palpation (Patient in sitting and lying position):
- Use pads of fingers in circular or vertical pattern
- Cover all quadrants of the breast and axillary tail
- Palpate axillary, supraclavicular, and infraclavicular lymph nodes
✅ 4. Abnormal Findings:
- Lump or hard mass
- Nipple discharge (especially bloody)
- Skin retraction, dimpling
- Peau d’orange (orange peel skin texture)
- Asymmetry or fixed mass
👩⚕️ PART B: Pelvic Examination
✅ 5. Purpose:
- Assess uterine and adnexal (ovary/tube) health
- Detect infections, bleeding, pain, or masses
- Evaluate cervical changes in pregnancy
- Perform Pap smear, speculum, or bimanual exam
✅ 6. Procedure for Pelvic Examination:
🔹 Preparation:
- Obtain informed consent
- Ask patient to empty bladder
- Place in lithotomy position (legs flexed, hips abducted)
- Drape for privacy
🔹 Steps:
1. Inspection of External Genitalia:
- Check labia, clitoris, perineum for swelling, discharge, lesions
2. Speculum Examination:
- Insert sterile lubricated speculum gently
- Visualize cervix and vaginal walls
- Look for discharge, bleeding, ulcers, masses
- Collect Pap smear or cervical swabs
3. Bimanual Examination:
- Insert two fingers into vagina, other hand on abdomen
- Assess size, position, consistency of uterus
- Palpate adnexa (ovaries, tubes)
4. Rectovaginal Exam (if indicated):
- Assesses posterior pelvic structures
- Done for masses or suspicion of rectal involvement
✅ 7. Abnormal Findings:
- Cervical erosion or polyps
- Masses or tenderness in uterus or adnexa
- Foul-smelling discharge (infection)
- Pelvic organ prolapse
- Signs of sexually transmitted infections (STIs)
✅ 8. Nursing Responsibilities:
- Ensure privacy, respect, and comfort
- Explain steps to reduce anxiety
- Prepare instruments: gloves, speculum, swabs
- Assist physician or midwife
- Support patient emotionally
- Educate about menstrual, sexual, and reproductive health
✅ 9. Golden One-Liners for Quick Revision:
- Breast exam best done 7–10 days after menstruation
- Peau d’orange indicates breast cancer
- Speculum exam allows direct view of cervix
- Bimanual exam assesses uterine and ovarian condition
- Always ensure informed consent and privacy during pelvic exams
✅ 10. MCQs for Practice:
Q1. The best time for a routine breast exam is:
a) During menstruation
b) Before menstruation
✅ c) 7–10 days after menstruation
d) Anytime
Q2. Peau d’orange appearance of the breast suggests:
a) Mastitis
b) Fibroadenoma
✅ c) Breast carcinoma
d) Milk engorgement
Q3. In pelvic examination, bimanual examination assesses:
a) External genitalia
b) Cervix only
✅ c) Uterus and adnexa
d) Vaginal walls
Q4. The position used for pelvic examination is:
a) Supine
b) Prone
✅ c) Lithotomy
d) Fowler’s
Q5. Which tool is used for visualization of the cervix during pelvic exam?
a) Forceps
✅ b) Speculum
c) Retractor
d) Tenaculum