Clinical methods in gynecology Flashcards
How should you start a gynecological consultation?
Begin with the patient history. Ask an open question. “How can I help you today?”
What is included in the “set template” for patient history gynecological consultation?
Age and occupation.
Previous pregnancies (numbers, outcomes, complications, miscarriages).
Menstruation (duration, intervals, bleeding amount, first day of last menstruation).
Menopause (if relevant) and menopausal complaint (e.g. hot flashes).
Sexual activity and partner, as well as use of contraceptives (both current and previous use).
Pain in the pelvic region (and relationship of pain to the menstrual cycle).
Function of urinary bladder and intestine.
Diseases, family history and use of medications.
Social factors, use of alcohol, smoking and drugs.
What is it important to do before you begin the clinical examination during a gynecological consultation?
Summarize the patient history and agree on a plan for the rest of the consultation in collaboration with the patient.
What are some special situations during a gynecological consultation where there is need for extra sensitivity?
Young women / first time having a gynecological consultation.
Women with a bad experience from a previous gynecological consultation.
Women who have not had intercourse.
Women with present pain.
Women with serious pelvic disease.
Women consulting for abortion.
Women with traumas (e.g. sexual abuse such as rape).
Name some indications to perform a gynecological examination.
Lower abdominal pain.
Vaginal bleeding (e.g. irregular bleeding or postmenopausal bleeding).
Urination and defecation problems.
Signs of infection in the pelvic area.
Pelvic tumors (there could be reason to take a pap smear or biopsy).
Insertion or removal of intrauterine devices (IUD).
Pregnancy.
To assess the progress of labor.
What are the normal cervix and uterine positions?
Retroflexed, retroverted, anteflexed, anteverted and midline positions.
What is the most common cervix and uterine position?
Anteverted and anteflexed position.
What is meant by retroverted retroflexed cervix and uterine position?
Retroverted refers to the angle of the cervix. The cervix i angled backwards (or dorsally). (Can also be described as the position the uterus is tipped in.)
Retroflexed refers to the flexion of the uterus. The uterus is flexed backwards (or dorsally). (Can also be described as the direction the fundus uteri is pointing.)
What is meant by anteverted anteflexed and uterine position?
Anteverted refers to the angle of the cervix. The cervix is angled forwards (or ventrally). (Can also be described as the position the uterus is tipped in.)
Anteflexed refers to the flexion of the uterus. The uterus is flexed forwards (or ventrally). (Can also be described as the direction the fundus uteri is pointing.)
What were the “take home” messages form the lecture on gynecological examination?
Take your time, do not rush.
Explain the procedure when needed.
Spot the patient groups in need of special attention.
Express your understanding of this demanding situation, express you empathy.
What are the three components of a gynecological examination?
Visual inspection of external genitalia.
Speculum examination to view the vagina and cervix.
Bimanual palpation to asses the internal pelvic organs (position, size, tenderness, masses).
How do you make a gynecological examination safe?
Always have a chaperone with you.
Always explain the procedure and why it is needed before examining.
Obtain verbal consent.
Ask the patient to empty their urine bladder before the examination.
Always wash your hands (before and after examination) and wear sterile plastic gloves.
Always use sterile instruments of appropriate size.
Use warm and lubricated speculum.
The examination room should be well lit.
