Reference Manual - IARC Screening Group

Performing Breast and Pelvic ExaminationsA tender adnexal mass in a woman with late or missed menses, irregularbleeding, a positive pregnancy test (if available) or other signs orsymptoms of pregnancy suggests an unruptured ectopic pregnancy. Thismust be evaluated immediately, preferably in a hospital with surgicalfacilities. If you are uncertain, ask another clinician to check your findings.• Before removing the fingers of your pelvic hand, gently pushposteriorly to check for tenderness or masses in the cul-de-sac (spacebehind the uterus and in front of the rectum).• If a rectovaginal examination is not necessary, go to Completing theExamination (page G-30).RECTOVAGINAL EXAMINATIONIn this section, you will learn:• How to verify findings of bimanual examination (e.g., determine theposition or size of the uterus or check for masses or tendernessposterior to the uterus)This examination should be performed only if the findings of bimanualexamination are confusing (e.g., inability to palpate the uterus in an obesewoman or there is tenderness posterior to the cervix) or if additionalinformation is required.PreparationBecause a rectovaginal examination is uncomfortable for most women, itshould be completed as quickly and gently as possible.• Explain to the woman what you intend to do and that the examinationmay make her feel like she has to move her bowels—but she will not.Ask the woman if she has moved her bowels today. If she hasn’t, give herthe option of doing so before the examination.• If you suspect the woman has a vaginal infection, you may want tochange the glove on your pelvic hand to avoid putting infectiousmicroorganisms from the vagina into the rectum. If you need tochange your gloves, before removing them, immerse both glovedhands in 0.5% chlorine solution, then remove them by turning theminside out. If disposing of them, place them in a leakproof containeror plastic bag. If reusing the gloves, submerge them in 0.5% chlorinesolution for 10 minutes for decontamination.Cervical Cancer Prevention Guidelines for Low-Resource Settings G-29