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Indications for Vaginal Examination

In Obstetrics (During Pregnancy and Labor):

1. To assess labor progress:
   
2. • Cervical dilatation and effacement
   • Fetal head position, station, and presentation
   • Status of membranes (intact or ruptured)
3. To confirm the onset of labor:
   
4. • Regular contractions with cervical changes
5. Before performing procedures:
   
6. • Artificial rupture of membranes (ARM)
   • Application of fetal scalp electrode
   • Instrumental delivery (forceps or vacuum)
7. 
   
8. Suspected complications:
   
9. • Premature rupture of membranes (PROM)
   • Preterm labor
   • Vaginal bleeding in late pregnancy (done with extreme caution)
10. 
    

In Gynecology:

1. To assess pelvic organs:
   
2. • Uterus size, position, and mobility
   • Adnexal masses (ovaries or fallopian tubes)
   • Cervical lesions
3. 
   
4. To investigate symptoms:
   
5. • Pelvic pain
   • Abnormal vaginal discharge or bleeding
   • Dyspareunia (pain during intercourse)
6. 
   
7. As part of routine pelvic exam:
   
8. • In combination with speculum and bimanual examination

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Contraindications of Vaginal Examination

• Placenta previa (suspected or known) – may cause hemorrhage
• Heavy vaginal bleeding – unless placenta previa has been ruled out
• Preterm labor with ruptured membranes – may increase infection risk

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What Is Assessed During Vaginal Examination (in Labor)

• Cervical dilation (0–10 cm)
• Cervical effacement (% thinning)
• Station of presenting part (relationship to ischial spines)
• Presentation (cephalic, breech, etc.)
• Position of fetus (occiput anterior/posterior)
• Membrane status (intact or ruptured)
• Presence of caput succedaneum or molding (indicates labor progress)

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Procedure Summary

1. Explain the procedure and obtain consent
2. Ensure privacy and comfort
3. Use sterile gloves and lubricating gel
4. Insert two fingers gently into the vagina
5. Assess cervix, fetal presentation, and other relevant findings
6. Document findings and inform the patient