What components are included in a normal female physical exam?

Normal Female Physical Examination Template

A comprehensive female physical examination should include specific components focusing on breast health, reproductive health, and general health assessment as recommended by multiple clinical guidelines. This template outlines the essential elements of a normal female physical examination based on current evidence.

General Components

• Vital signs (blood pressure, heart rate, respiratory rate, temperature)
• Height and weight measurements
• Body mass index (BMI) calculation
• General appearance assessment
• Skin examination for lesions, rashes, or abnormal pigmentation
• Head and neck examination (thyroid, lymph nodes, oral cavity)
• Cardiopulmonary examination
• Abdominal examination
• Neurological examination
• Musculoskeletal assessment

Breast Examination

Visual Inspection

• Inspect breasts with patient in sitting position with arms at sides, then raised overhead, and with hands pressed on hips 1
• Note breast symmetry, contour, skin changes, nipple appearance, and any visible masses
• Check for nipple discharge, eczematoid changes, or discoloration 1

Palpation

• Examine with patient in supine position
• Systematic palpation of all breast quadrants and axillary tail
• Note any masses, tenderness, or thickening
• Assess tumor size (if palpable) and location 1
• Examine axillary and supraclavicular lymph nodes for enlargement 1

The American Cancer Society recommends clinical breast examinations every 3 years for women ages 20-39 and annually for women 40 and older 1. The examination should be performed prior to mammography in women aged 40 and older 1.

Pelvic Examination

External Genitalia Examination

• Inspect vulva for lesions, inflammation, or anatomic abnormalities
• Assess for signs of infection or skin conditions

Speculum Examination

• Visualize cervix and vaginal walls
• Collect specimens for Pap test and/or STI screening as indicated
• Note any abnormal discharge, lesions, or inflammation

Bimanual Examination

• Assess uterine size, shape, position, and mobility
• Evaluate for adnexal masses or tenderness
• Note any cervical motion tenderness

The American College of Obstetricians and Gynecologists (ACOG) recommends that pelvic examinations be performed when indicated by medical history or symptoms rather than as a routine screening in asymptomatic women 2. Pelvic examinations should be performed for women with current or history of cervical dysplasia, gynecologic malignancy, or specific symptoms 2.

Cancer Screening Components

Cervical Cancer Screening

• Cervical cancer screening should begin approximately 3 years after a woman begins having vaginal intercourse, but no later than 21 years of age 1
• Screening should be done every year with conventional Pap tests or every 2 years using liquid-based Pap tests
• After age 30, women with three normal test results may be screened every 2-3 years 1

Colorectal Cancer Screening

For women aged 50 years and older, options include:

• Annual fecal occult blood test (FOBT) or fecal immunochemical test (FIT)
• Flexible sigmoidoscopy every 5 years
• Colonoscopy every 10 years
• Double contrast barium enema every 5 years 1

Endometrial Cancer Awareness

• At menopause, women should be informed about risks and symptoms of endometrial cancer
• Encourage reporting of any unexpected bleeding or spotting 1

Special Considerations

For Infertility Evaluation

• Thorough reproductive history
• Assessment of secondary sex characteristics and body habitus
• Thyroid examination
• Evaluation for signs of PCOS or other endocrine disorders 1

For Irregular Menstrual Cycles

• Careful assessment for signs of hyperandrogenism (acne, hirsutism)
• Evaluation for acanthosis nigricans (sign of insulin resistance)
• Assessment for galactorrhea (hyperprolactinemia) 1, 3

Documentation Recommendations

Document the following for each examination component:

• Normal findings
• Abnormal findings with detailed description
• Patient education provided
• Recommended follow-up or referrals

Age-Specific Considerations

Adolescents and Young Adults (18-39 years)

• Clinical breast examination every 3 years 1
• Cervical cancer screening as per guidelines
• Assessment of menstrual patterns and reproductive health

Middle-Aged Women (40-64 years)

• Annual clinical breast examination 1
• Annual mammography starting at age 40 1
• Continued cervical cancer screening
• Colorectal cancer screening starting at age 50 1

Older Women (65+ years)

• Continued annual clinical breast examination
• Annual mammography
• Colorectal cancer screening
• Consideration of bone health assessment

Remember that the physical examination should be tailored based on the patient's age, risk factors, and presenting concerns. The decision to perform specific components should involve shared decision-making between the patient and provider.