Physical examination – female

Physical examination is an essential part of a comprehensive continence assessment (CCA).

Before undertaking a physical examination you must gain consent from the woman.

The consenting process involves explaining to the woman what is involved and ensuring that she understands what she is consenting to. You must also establish whether a chaperone is required.

The women should be made comfortable in a semi-recumbent, supine position for the examination which includes:

1. Visual examination of skin condition – looking for redness, rashes, excoriation.

2. Visual examination, with labia parted to expose the vulval mucosa (healthy mucosa should be moist and deep pink in colour) – looking for scar tissue, lesions, excoriation, soreness, irritation, signs of atrophic vaginitis, signs of bulging or vaginal prolapse.

   Observe for unpleasant odours or smells or discharge.

3. With a full bladder ask the individual to cough whilst still observing the vulval area:

   i). An immediate squirt of urine with coughing indicates symptoms of stress incontinence.

   ii). A delayed urine leakage suggests symptoms of urge incontinence/overactive bladder.

   iii). Perineal descent or signs of vaginal prolapse may also be observed on coughing.

4. Ask the woman to contract/’squeeze’ her pelvic floor muscles when lying and observe for a muscle contraction. Observe for tightening of the muscles – indicates a pelvic floor contraction of grade 3 (moderate) or above on the Oxford Scale.

   If no tightening observed this suggests a weak or no pelvic floor muscle power.

5. Assess pelvic floor muscle tone by digital vaginal examination^[1]: Undertake routine digital assessment to confirm pelvic floor muscle contraction before the use of supervised pelvic floor muscle training for the treatment of UI^[2][2006, amended 2013]. The assessor must be competent.

Did you know? If a female has loaded colon/severe constipation then this can be felt on vaginal examination.

References

_{1. Laycock J, Jerwood D. Pelvic Floor Muscle Assessment: The PERFECT Scheme. Physiotherapy. December 2001;87:12;631-642 [Cited 28 August 2018] Available from: https://doi.org/10.1016/S0031-9406(05)61108-X}

_{2. Nice Clinical Guideline CG171. Urinary incontinence in women: management. [Last updated July 2018; Cited 1 August 2018] Available from: https://www.nice.org.uk/guidance/cg171}