Gynaecological Examination

Answer 1

1. Do you have any gynaecological disease?
2. Do you have any discomfort?
3. LMP? Is there any residual bleeding?
4. Are you married?
5. Any sexual activity?
6. What contraceptives do you use?
7. Have you ever had a gynaecological examination?

Question 2

How would you explain a gynaecological examination to a patient?

Answer 2

1. We have to place speculum into vagina to look at the cervix
2. We take the cytology brush and take samples from the cervix
3. After the speculum examination, we do a PV

There will be some discomfort. If there is too much pain, please feel free to stop us anytime.

Question 3

Systematic general examination

Answer 3

• Blood pressure, pulse, temperature
• Body weight and height
• General appearance
• Thyroid
• Breasts
• Cardiovascular system
• Respiratory system

Question 4

What should we do in an abdominal examination?

Answer 4

• Always perform abd examination before proceeding to pelvic examination
• Inspect: surgical scars, abdominal distension
• Palpate: tenderness and other peritoneal signs, masses, groin lymph nodes
• Percuss: shifting dullness (if appropriate)
• Auscultate: bowel sounds (if appropriate)

Question 5

Pelvic examination steps:

Answer 5

Abdominal examination:
1. Palpate all quadrants of the abdomen
2. Palpate from the middle of the upper abdomen and slowly downwards to feel for a pelvic mass (Feel for enlarged uterus. Describe uterine size by gestational age)

Proceed with pelvic examination [wear gloves]
1. Explain to the patient
2. Inspection: perineum, external genitalia for skin lesions, obstetric scars, hair distribution
3. Check the instrument. Select the right sized speculum. Check that it functions well (open and closes well, screws in okay)
4. Lubricate the instrument with KY jelly
5. Part the labia. Try not to touch the clitoris
6. Insert the speculum: Follow the contour of the anatomy. Slowly turn it horizontally and point the speculum downwards and insert it all the way in [Turn the speculum in the introitus, NOT inside the vagina]
7. Hold onto the speculum and open the blades [do slowly and gently] to see the cervix. Fix the speculum
8. Pick up the cervix brush, identify the Os and turn the cervix brush 5 times.
9. Take out cervix brush and put it in the medium.
10. Take out speculum slowly and make sure not to clip vaginal wall. Look for vaginal lesions as you come out.

Question 6

What lubricant should be used?

Answer 6

• In the past, water was used as a lubricant because gel lubricant causes unsatisfactory cytology results on conventional smears using glass slides
• Now, when liquid-based cytology is used, either water or gel lubricant can be used

Question 7

How to do digital bimanual examination?

Answer 7

1. Insert two fingers in and feel the cervix
2. Press the posterior fornix upwards with your two fingers and press downwards with other hand onto abdomen. Here you can feel the uterus.
3. Put your finger in lateral fornices and press gently while tilting up. Palpate for any adnexal mass.
4. Demonstrate cervical excitation. Move it gently. If she jumps up in pain, she has cervical excitation.
5. Take out your finger and tell the woman that you are done with the PVE

Question 8

How to record your findings?

Answer 8

• BP 120/80 mmHg, pulse 80/min regular
• Temperature 36.9ºC
• Body weight 56 kg, height 162 cm, BMI 21.3 kg/m2
• General condition well
• Thyroid – normal
• Breasts – normal
• Cardiovascular system – normal
• Respiratory system – normal
• Abdomen – soft, non-tender, no scar, no mass, no groin lymph nodes
• Vulva – normal, no local lesion
• Vagina – normal, no abnormal discharge, no blood
• Cervix – normal, no local lesion, no excitation tenderness
• Uterus – normal-sized, anteverted (or retroverted), regular, mobile
• Adnexae - no mass, non-tender