Breast Exam Techniques and Protocols

Introducing yourself to the patient, stating your name, role, and pronouns, and asking them how they would like to be addressed.

Explaining the purpose of the breast and pelvic exam to the patient, including inspecting and palpating breasts, pelvic examination, and obtaining a pap smear, and obtaining informed consent.

Providing the patient with a gown and ensuring privacy for them to change before the exam.

Inspecting the patient's breasts for size, shape, contour, dimpling, skin color, edema, and venous pattern while the patient stands and leans forward.

Inspecting the patient's nipples for size, shape, direction, rashes, and ulceration while the patient stands and leans forward.

Inspecting the patient's breasts for size, shape, contour, dimpling, skin color, edema, and venous pattern while the patient sits with their hands by their sides.

Inspecting the patient's nipples for size, shape, direction, rashes, and ulceration while the patient sits with their hands by their sides.

Inspecting the patient's breasts for size, shape, contour, dimpling, skin color, edema, and venous pattern while the patient sits with their hands on their hips.

Inspecting the patient's nipples for size, shape, direction, rashes, and ulceration while the patient sits with their hands on their hips.

Inspecting the patient's breasts for size, shape, contour, dimpling, skin color, edema, and venous pattern while the patient sits with their hands pressed together above their head.

Inspecting the patient's nipples for size, shape, direction, rashes, and ulceration while the patient sits with their hands pressed together above their head.

Palpating the patient's right breast with their right hand behind their head using a linear pattern with the pads of your fingers.

Palpating the patient's left breast with their left hand behind their head using a linear pattern with the pads of your fingers.

Describing any masses noted during breast palpation, including location, size, shape, mobility, consistency, and tenderness.

Palpating the patient's nipples using your thumb and index finger, noting elasticity and any discharge.

Gathering necessary supplies for the pelvic and/or pap smear exam including a vial, gloves, cervical broom, lubricant, speculum, and tissues.

Explaining the need for a chaperone to be present during the pelvic exam.

Ensuring the patient is positioned properly for the pelvic exam by extending the stirrups, asking the patient to move their buttocks, place their heels in the stirrups, and lie back in the lithotomy position.

Inspecting the external genitalia including the mons pubis, labia majora, labia minora, urethra, clitoris, vaginal introitus, perineum, and anus.

Inspecting and palpating Skene's and Bartholin's glands for any abnormalities.

Assessing for cystocele, incontinence, and rectocele by asking the patient to cough and bear down.

Lubricating the speculum and gently inserting it into the vagina while asking the patient to relax.

Identifying any abnormalities on the cervix, including the transformation zone, and documenting findings.

Collecting a sample for the pap smear using a cervical broom, rotating it 3-5 times against the cervix, and placing the collected sample in a labeled vial.

Gently removing the speculum from the vagina without pinching the vaginal wall, while slowly rotating and pulling it out at the same angle it was inserted.

Palpating the cervix for motion tenderness while inserting two lubricated fingers into the vaginal canal and applying pressure to the mid-lower abdomen.

Palpating the ovaries, adnexa, and uterus by moving fingers internally and applying pressure with the nondominant hand.

Discarding used gloves and providing tissue for the patient to clean themselves.