You are due to be admitted to hospital for a gynaecology or urogynaecology procedure under general anaesthetic (while you are asleep).
This leaflet explains internal vaginal examination under anaesthetic which is often necessary as part of gynaecological and urogynaecological procedures.
Why do I need a vaginal examination under anaesthetic?
Vaginal Examination Under Anaesthetic is often necessary for the complete assessment of gynaecological and urogynaecological conditions and for the appropriate (best) treatment of them.
Prior to your procedure your doctor will ask for your consent by explaining the planned procedure(s) to you and why they are necessary to investigate or help improve your condition(s) as well as discussing your preferences with you.
What happens during a vaginal examination under anaesthetic?
The importance of a vaginal examination under anaesthetic is to help further investigate your condition and make decisions about your symptoms or surgical procedure.
The phrase ‘vaginal examination under anaesthetic’ may include some or all of the following:
1) Visual and / or touch inspection of the vulva
(Lips, clitoris, vaginal opening, perineum, anus).
2) Bimanual internal vaginal examination
Gently inserting 1- 2 gloved and lubricated finger/s into the vagina whilst pressing on the stomach/belly to assess the size of the uterus (womb), ovaries or any pelvic masses.
3) Speculum examination
A speculum is a tubular instrument (used during a routine smear test) which is inserted gently into the vagina and allows inspection of the vaginal skin and the cervix (neck of the womb).
Please note
Your doctor will discuss which method/s is appropriate for you.
Special notes
Symptoms of pelvic or vulval pain
If you have symptoms of pelvic or vulval pain, vaginal examination under anaesthetic can help further detect any possible causes contributing to your symptoms without discomfort.
Urogynaecology
Urogynaecology is a specialised area of gynaecology treating problems related to the bladder, urethra, pelvic floor muscles, vagina, cervix, uterus (womb), rectum and anus. Symptoms from one area can often be linked with issues nearby meaning that vaginal examination under anaesthetic can help further investigate your condition/symptoms and can help guide the doctors on what the correct or most helpful treatment may be.
Examples of urogynaecology procedures that may involve a vaginal examination under anaesthetic include but are not limited to: prolapse surgery, incontinence surgery and cystoscopy.
Anal / rectal examination
If required, this is carried out with a single gloved and lubricated finger. Occasionally a tube called a proctoscope, like a vaginal speculum, may be used to look at the skin inside the back passage.
Laparoscopy / robotic assisted keyhole surgery / laparoscopic hysterectomy
As part of your laparoscopy (keyhole surgery), it may be necessary to perform a vaginal examination under anaesthetic in order to insert an instrument into the uterus (womb) to help visualise the organs within your pelvis better and help move the uterus to aid your procedure.
During a laparoscopic hysterectomy, instrumentation of the uterus (womb) helps assist your procedure and aids the removal of your womb through your vagina.
During these procedures the bladder is also emptied with a catheter.
Hysteroscopy
This procedure involves a telescopic camera passing through the vagina, into the cervix and inside the uterus (womb). A vaginal examination under anaesthetic assesses the tilt of the uterus allowing the safe passage of the camera to visualise the uterus.
A vaginal examination under anaesthetic can also help give information about your symptoms- such as the source of abnormal or irregular bleeding.
Hysterectomy performed by open surgery (laparotomy)
A vaginal examination under anaesthetic can help determine the type and size of incision needed for your surgery depending on the size and location of the uterus (womb)/pelvic mass. This information is needed at the time of your surgery to appropriately prepare for your operation.
During a hysterectomy performed by open surgery (laparotomy) a catheter is usually inserted into the bladder to drain it. This catheter will often be in place for 24 hours.
As part of the consent process your doctor will provide more information regarding the vaginal examination under anaesthetic you may need during your procedure. Please ask questions if you don’t fully understand or have any concerns about what is proposed. If you wish to decline a vaginal examination under anaesthetic, this can be discussed with your team and a decision made based on your preferences and clinical need for examination on the day of your procedure. You should be reassured that your care under anaesthesia is conducted with professionalism and respect for your dignity at all times.
Informed Consent
This leaflet is provided to supplement verbal information that will be given to you by your healthcare provider (Doctor/Surgeon/Nurse) as part of the consent process prior to your procedure. Information sharing between you and the clinician is essential to ensure that your decision to consent is fully informed.
Please ask questions if you don’t fully understand or have any concerns about what is proposed. You have a right to be involved in these decisions and should feel supported to do so. Please take the time to consider what is important to you to ensure the information you receive is specific and individualised.