| Examination
|
Condition
|
| External genitalia | |
| Assess muscle tone | Vaginismus |
| Assess skin color and texture | Vulvar dystrophy, dermatitis |
| Assess skin turgor and thickness | Atrophy |
| Assess pubic hair amount and distribution | Atrophy |
| Expose clitoris | Clitoral adhesions |
| Assess for ulcers | Herpes simplex virus |
| Perform cotton swab test of vestibule | Vulvar vestibulitis |
| Palpate Bartholin glands | Bartholinitis |
| Assess posterior forchette and hymenal ring | Episiotomy scars, strictures |
| Monomanual | |
| Palpate rectovaginal surface | Rectal disease |
| Palpate levator ani | Levator ani myalgia, vaginismus |
| Palpate bladder/urethra | Urethritis, interstitial cystitis, urinary tract infection |
| Assess for cervical motion tenderness | Infection, peritonitis |
| Assess vaginal depth | Postoperative changes, postradiation changes, stricture |
| Bimanual | |
| Palpate uterus | Retrogression, fibroids, endometritis |
| Palpate adnexa | Masses, cysts, endometriosis, tenderness |
| Perform rectovaginal examination | Rule out endometriosis |
| Obtain guaiac test | Bowel disease |
| Speculum | |
| Evaluate discharge, pH | Vaginitis, atrophy |
| Evaluate vaginal mucosa | Atrophy |
| Perform Papanicolaou smear | Human papillomavirus infection, cancer |
| Assess for prolapse | Cystocele, rectocele, uterine prolapse |
Adapted with permission from Phillips NA. The clinical evaluation of dyspareunia. Int J Impot Res 1998;(suppl 2):S117-20.