Summary: Genital examination in women

Genital examinations should only be carried out by health care professionals who are registered, trained and competent.

While there is no single nationally recognised training programme, some extended roles—such as colposcopy—require specific qualifications.

Midwives routinely carry out vaginal examinations. Nurses involved in procedures, like hysteroscopy or intrauterine device fitting, must also be skilled in bimanual genital examination.

Health care assistants and support workers do not undertake examinations requiring clinical judgment, but may help with preparation and chaperoning, if appropriately trained.

A genital examination may be needed to:

• investigate symptoms like pain, bleeding, discharge or lumps
• collect samples or swabs (for example, cervical screening or STI testing)
• fit or check intrauterine devices
• assess prolapse, infections, trauma, incontinence or suspected abuse.

Health care professionals should confirm:

• the woman’s understanding and reason for the examination
• valid consent, including her right to withdraw at any time
• whether she would like a chaperone or a familiar person present
• privacy and comfort throughout.

Check for any allergies (for example, latex, iodine) and explain what the woman can expect, including sensations, equipment and sounds. Provide clear, respectful language and allow time for questions.

Women should be given privacy to undress. A clean gown, tissues and sanitary products should be available.

Ensure:

• the room is private
• the couch faces away from the door
• lighting is safe and effective
• the woman is comfortable
• time is given to proceed at her pace.

• Inspect the skin and hair pattern on the abdomen.
• Check inguinal lymph nodes for swelling or tenderness.
• Palpate the abdomen gently from the umbilicus to the pubic bone to assess the uterus—note size, position and tenderness.
• For midwives, assess foetal lie, position and gestation. Use light palpation to detect tenderness or resistance; proceed to deep palpation if tolerated.
• Note any pain, guarding or masses. Rebound tenderness may indicate serious conditions, such as peritonitis/appendicitis—refer if suspected.

Inspect for:

• lesions, swelling, infection, scarring, varicosities, ulcers or discharge
• signs of trauma or female genital mutilation (FGM)
• changes in skin colour or texture
• hair distribution and overall sexual maturity.

Palpate gently, noting tenderness, masses or gland enlargement.

Depending on the reason for the examination, digital vaginal examination may be performed before or after using a speculum.

• Part the labia and insert a gloved and lubricated index and middle finger into the vagina.
• To assess the genital floor tone, ask the woman to ‘bear down’ and ‘squeeze’.
• If using a speculum, insert gently, asking the woman to cough or relax her muscles.

Where clinically indicated, examination of a pregnant woman with a speculum is considered low risk and can be performed safely by a nurse who has received training.

Swabs can be taken safely from pregnant women where clinically indicated. Cervical screening is usually delayed until 12 weeks postpartum.

Performed by trained professionals to assess the uterus and ovaries:

• insert one or two fingers internally while the other hand palpates the abdomen
• check uterus position, size, mobility and tenderness
• palpate adnexae (ovaries and tubes) for any masses or sensitivity.

If findings raise concern (pain, masses or cervical motion tenderness), refer immediately.

Allow time and privacy for the woman to dress and provide tissue or washing facilities if needed.

Document findings accurately, including:

• condition of abdomen, cervix, vagina, uterus, external genitalia and adnexae
• size, tenderness, consistency and any abnormalities
• if swabs or samples were taken, explain when and how results will be shared.

Genital examination is a health test entirely removed from sexual activity. Virginity status should not influence whether a woman is offered or consents to an examination.

Some women may need more time or reassurance, particularly if they have:

• experienced sexual abuse, domestic violence or trauma
• never had a vaginal examination before
• mental or physical health concerns impacting the procedure.

In these cases, offer to discuss and reschedule. Never proceed if the woman is distressed, unable to consent or you feel the woman is not physically or mentally able to cope with it.

All findings must remain confidential, unless safeguarding concerns arise.

Documentation must be clear, accurate and stored securely, in line with professional and legal requirements.

Women should be reassured that their dignity, privacy and personal information will be respected at every stage.

Health care professionals must be alert to specific needs, including:

• survivors of abuse, trafficking or modern slavery
• those with conditions like vaginismus, atrophic vaginitis or pelvic pain
• women from cultures where FGM is practised—FGM is illegal and must be reported if identified in under-18s.

Supportive and non-judgemental care, including appropriate referrals (for example, counselling, psychosexual therapy or pelvic health physiotherapy), should always be offered.

All women should be offered a chaperone. The chaperone acts as a witness to consent and ensures dignity and comfort throughout. If declined, this should be recorded.

Professionals should also consider having a colleague present to protect both parties.

This guidance does not include information on the examination of a child, which should only be carried out by specialist staff.

The age of the child and the reason for the examination should be considered. It may be necessary to carry out the examination under anaesthetic, particularly in young children.

Genital examination is a routine but intimate procedure that requires care, dignity and clinical skill.

By ensuring informed consent, clear communication and timely referral when needed, health care professionals can make the experience safe, respectful and effective.

The full PDF explores this topic in more detail. The publication may include case studies, images, tables, good practice checklists, glossaries and suggested questions to ask patients. You’ll also find a concise list of references and links to useful organisations and websites.