Following perineal observation, with patient in crook lying position

• Explain the palpation procedure to patient and obtain consent.

• Prepare examination gloves, gel and tissues, and check with the patient for latex and gel allergy. Use vinyl gloves for preference.

• Wash hands, put on gloves and apply a little gel on the palpating gloved finger(s).

• Gently part the labia and insert one finger in the outer one-third of the vagina.

• Ask the patient whether she feels comfortable.

• If appropriate, insert the second finger.

• Ask the patient to lift in and squeeze around the finger(s) and observe or control the action so that the pelvis is not moving or the hip adductor or gluteal muscles are not contracted.

• Give feedback of correctness, performance and strength.

• Record whether PFM contraction is:

– Correct;

– only possible with visible co-contraction of other muscles;

– not present;

– in the opposite direction (straining or Valsalva).

• To record the maximum voluntary contraction (MVC) request a 3–5 s maximum effort PFM contraction after one or two submaximal ‘practice’ contractions. If you do not have a sensitive, reliable and valid tool to measure strength, use the Oxford grading scale to record the MVC. Separately record the lift component as absent, partial or complete.

• Note the voluntary relaxation after these contractions and record this as absent, partial or full.

• If no further vaginal measurements are to be made, discard the examination gloves into the appropriate waste disposal and allow the patient privacy for dressing.