Female Pelvic Exam Flashcards
What are common chief complaints that warrant a pelvic exam?
Abdominal or pelvic pain Abnormal vaginal bleeding Absence/cessation of menses Painful menses Decreased libido Difficulty getting pregnant Painful intercourse Pelvic/abdominal mass Symptoms of menopause Vaginal discharge Vulvovaginal itchiness
What questions are included in the gynecologic history?
- Ask about the age of menarche (when the first menses started); in the United States the range is between the ages of 9 and 16
- Ask about menstruation patterns
- If applicable, at what age did menopause occur?
What questions are included in the menstruation patterns?
How often does the patient have menses? (Every 24 to 32 days is normal.)
How long are the menses? (3 to 7 days is normal.)
How heavy are the menses? (The number of pads or tampons used is an indicator.)
What is the definitions of menopause?
Menopause is defined as no menses for 12 months. The average age of menopause is 45 to 52 years.
Define amenorrhea
Amenorrhea is defined as the absence of menses
Define primary amenorrhea
Primary amenorrhea refers to the failure of menses to be initiated (causes: chromosomal abnormalities, malnutrition, hypothalamic-pituitary-ovarian dysfunction)
Define secondary amenorrhea
Secondary amenorrhea refers to a cessation of periods after they have previously existed (physiologic causes: pregnancy, breast feeding, menopause; pathologic causes: pituitary tumor, hypothyroidism, anorexia nervosa)
Define dysmenorrhea
painful periods with cramping or aching in the lower pelvis and lower back
Define PMS
Complex of symptoms occurring 4 to 10 days before the onset of menses
Psychological symptoms include tension, irritability, depression, and mood swings
Physical symptoms include weight gain, bloating, edema, headaches, and breast tenderness
Define polymenorrhea
Polymenorrhea means having too frequent of periods
Define Menorrhagia
Menorrhagia refers to an increased amount of bleeding or duration of flow
Define Metrorrhagia
Metrorrhagia is bleeding that occurs between periods
What questions need to be asked about pregnancy?
How many pregnancies in total? How many births were term? Preterm? Miscarriages? Induced abortion?
Were there any complications in prenatal care, labor, or delivery?
What kind of birth control is currently used or desired?
What questions need to be asked about vulvovaginal sxs?
burning, itching, and the quantity and quality of discharge (including texture, amount, color, and smell)
What questions need to be asked about the pt’s sex life?
Ask about sexual preference and sexual response; be professional and “matter of fact” in questioning and never assume all patients are heterosexual
Ask open-ended questions such as, “How is sex for you?” “Is your partner satisfied with your sex life?”
What questions need to be asked about sexual dysfunction?
Lack of interest
Lack of physiologic response to desire (decreased lubrication)
Lack of orgasm
Dyspareunia, or discomfort during intercourse
Vaginismus, or spasms of the muscles surrounding the vagina making penetration painful and difficult
What educational material does the pt need?
Cervical cancer screening: Pap smear and HPV screening
Options for family planning
Sexually transmitted diseases and HIV
Changes in menopause
How should the pt be positioned for the pelvic exam?
Lie on the back, with head and shoulders elevated (such as on a pillow), with arms to the side or folded across the chest to reduce tightening the abdominal muscles
How should the examiner set up the pelvic exam?
- Obtain permission
- Explain each step of the examination in advance; select a chaperone
- Drape the patient from the abdomen to the knees
- Avoid sudden movement
- Choose a speculum of appropriate size
- Warm the speculum with tap water
- Monitor the comfort of the examination by watching the patient’s face
- Use gentle insertion of the speculum
What is the Proper Sequence of the Female Genital Examination?
- Examine external genitalia
- Perform speculum examination
- Perform bimanual examination
- Perform rectovaginal examination
- Perform rectal examination
What is involved in the Inspection of the female patient’s external genitalia?
Mons pubis Labia majora and minora Clitoris Urethral meatus Introitus Perineum Note any inflammation, discharge, swelling, or nodules; palpate any lesions
How is the Bartholin’s gland inspected?
Check the Bartholin’s glands by inserting the index finger into the vagina and placing the thumb at the posterior labia; palpate between finger and thumb
How is the Internal Exam by Speculum performed?
- Place the index finger of your non-dominant hand on the posterior portion of the introitus and push down gently
- With the speculum in your dominant hand, turn it to the entry angle (approximately 45 degrees) and gently insert into the introitus; continue inserting the length of the speculum
- Rotate the speculum horizontally and gently open it, catching the cervix in between the blades; it is common to have to close the speculum and reposition the blades to locate the cervix
How is the cervix inspected?
- Once the cervix is visualized, inspect the cervix and the os; note the color, position, and characteristics of the cervix
- Look for discharge or bleeding from the os
Note any ulcerations, masses, or nodules on the cervix - Obtain one specimen from the endocervix and one from the ectocervix, or a combination specimen using the cervical brush “broom”
A. If indicated, obtain cultures for chlamydia, gonorrhea, or herpes; wet prep (saline slide of the vaginal and cervical secretions) for vaginitis
