Gynae Examination

Question 1

What is a Sim’s Speculum?

Answer 1

Double-bladed instrument

Used for better inspection of vaginal walls and prolpase
Patient positioned in left lateral position (different to CUSCO speculum)
Press one end into posterior vagina to visualise anterior wall and vice versa
Ask patient to bear down to asses prolapse of wall, cervix, or vaginal vault

Question 2

Is a rectal examination ever appropriate as part of a Gynae exam?

Answer 2

1) If posterior wall prolapse –> rectal exam can distinguish between enterocoele and rectocoele

Enteroceole: small bowel pushing on posterior of vagina ( herniation of the peritoneal sac between the vagina and the rectum)

Rectocoele: anterior wall of rectum pushing on posterior of vagina (herniation of the front wall of the rectum into the back wall of the vagina)

2) if assessing for malignant cervical disease –> rectal examination
3) assessment for rectovaginal endometriosis –> rectal examination