Gynecologic pelvic examination
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Gynecologic pelvic examination
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Gynecologic pelvic examination
- 1. 15.11.2014 1 tevfik@yoldemir.com Tevfik Yoldemir, MD, BBA Marmara University Department of Obstetrics and Gynecology Division of Reproductive Endocrinology and Infertility PELVIC EXAM tevfik@yoldemir.com PositioningPositioning Move the pillow down to her headMove the pillow down to her head Help her place her heels into the stirrupsHelp her place her heels into the stirrups Buttocks are on the edge of the tableButtocks are on the edge of the table Ask her to relax her legs to the sideAsk her to relax her legs to the side tevfik@yoldemir.com tevfik@yoldemir.com Lithotomy PositionLithotomy Position tevfik@yoldemir.com tevfik@yoldemir.com External GenitaliaExternal Genitalia Mons pubisMons pubis Tanner’s pubic hair distributionTanner’s pubic hair distribution Excoriations or papules (lice)Excoriations or papules (lice) Labia minora and majoraLabia minora and majora Bartholin’s glandsBartholin’s glands InflammationInflammation UlcerationUlceration NodulesNodules
- 2. 15.11.2014 2 tevfik@yoldemir.com tevfik@yoldemir.com External GenitaliaExternal Genitalia ClitorisClitoris Clitoromegaly: Enlarged clitorisClitoromegaly: Enlarged clitoris Milk urethraMilk urethra Urethral diverticulumUrethral diverticulum Periurethral glandsPeriurethral glands UrethritisUrethritis HymenHymen Perineal bodyPerineal body ScarsScars AnusAnus External hemorrhoidsExternal hemorrhoids tevfik@yoldemir.com BARTHOLIN’S CYSTBARTHOLIN’S CYST tevfik@yoldemir.com Gynecologic ExamGynecologic Exam Separate the labia:Separate the labia: Ask the patient to coughAsk the patient to cough Supine stress testSupine stress test Ask the patient to bear downAsk the patient to bear down CystocoeleCystocoele RectocoeleRectocoele tevfik@yoldemir.com tevfik@yoldemir.com Vaginal ExamVaginal Exam Warm the speculumWarm the speculum Lubricate the speculum with water or gelLubricate the speculum with water or gel Good lightingGood lighting Have supplies for Pap smear and culturesHave supplies for Pap smear and cultures Use the correct size of speculumUse the correct size of speculum
- 3. 15.11.2014 3 tevfik@yoldemir.com Inserting the speculumInserting the speculum Choose the right sizeChoose the right size Lubricate the speculumLubricate the speculum Separate the labia with your other handSeparate the labia with your other hand Avoid the urethraAvoid the urethra Angle the speculum downwardAngle the speculum downward Open the speculum when fully inserted toOpen the speculum when fully inserted to visualize the cervixvisualize the cervix tevfik@yoldemir.com tevfik@yoldemir.com Inspect the cervixInspect the cervix Squamocolumnar junctionSquamocolumnar junction ColorColor UlcerationsUlcerations MassesMasses BleedingBleeding DischargeDischarge tevfik@yoldemir.com tevfik@yoldemir.com Normal CervixNormal Cervix tevfik@yoldemir.com Cervical EctopyCervical Ectopy
- 4. 15.11.2014 4 tevfik@yoldemir.com Papanicolaou smearPapanicolaou smear Spatula: Put the longer end in the os and turnSpatula: Put the longer end in the os and turn 360 degrees360 degrees Cervical brush: Insert into the os and turn 360Cervical brush: Insert into the os and turn 360 degreesdegrees Smear the slide and immediately use aSmear the slide and immediately use a fixativefixative Obtain cultures from cervix and swab fromObtain cultures from cervix and swab from posterior fornixposterior fornix tevfik@yoldemir.com tevfik@yoldemir.com As you withdraw the speculum, open itAs you withdraw the speculum, open it slightly to avoid pulling on the cervixslightly to avoid pulling on the cervix Observe all four walls of the vaginaObserve all four walls of the vagina DischargeDischarge UlcersUlcers MassesMasses tevfik@yoldemir.com Bimanual ExamBimanual Exam Lubricate the index and middle fingersLubricate the index and middle fingers Insert your fingers pressing posteriorlyInsert your fingers pressing posteriorly Palpate the vaginal fornicesPalpate the vaginal fornices Palpate the cervixPalpate the cervix PositionPosition ShapeShape Motion tendernessMotion tenderness tevfik@yoldemir.com Bimanual ExamBimanual Exam Palpate the uterusPalpate the uterus Place your otherPlace your other hand on thehand on the abdomen aboveabdomen above the pubicthe pubic symphysissymphysis SizeSize ShapeShape TendernessTenderness MassesMasses tevfik@yoldemir.com
- 5. 15.11.2014 5 tevfik@yoldemir.com Bimanual ExamBimanual Exam Palpate the ovariesPalpate the ovaries Place your vaginalPlace your vaginal hand to the side ofhand to the side of the cervix, yourthe cervix, your opposite hand in theopposite hand in the same side lowersame side lower abdominal quadrantabdominal quadrant SizeSize ConsistencyConsistency TendernessTenderness MobilityMobility tevfik@yoldemir.com Rectovaginal ExamRectovaginal Exam Change glovesChange gloves Lubricate your fingersLubricate your fingers Insert the index finger intoInsert the index finger into the vagina and the middlethe vagina and the middle finger into the rectumfinger into the rectum Ask the patient to bearAsk the patient to bear downdown Palpate the posterior cervixPalpate the posterior cervix Palpate the uterosacralPalpate the uterosacral ligamentsligaments Palpate the rectovaginalPalpate the rectovaginal septumseptum tevfik@yoldemir.com Complete the examComplete the exam Offer her a washcloth to remove theOffer her a washcloth to remove the lubricantlubricant Help her to a sitting positionHelp her to a sitting position Explain the findings and the testsExplain the findings and the tests performedperformed