Pelvic Exam Flashcards
Anatomy of female rectal and genitourinary system
SEE DIAGRAM
Understand physiology of female menstrual cycle
See Diagram
Setting and equipment appropriate to the performance of the pelvic exam
Setting: Ensure privacy, comfortable room temperature and female chaperone. Explain in general terms what you are going to do. Marked anxiety before an exam may be a sign that something is not quite right. Find source of anxiety before exam.
Equipment:
· Exam Table Equipped with Footrests
· Flexible Light Source
· Vaginal Specula in Various Sizes
- chosen based on body habitus, age, parity
- Pederson (thinner bill)
- Grave (rounded bill)
- plastic disposable, metal reusable
· Warm Running Water
· Lubricating Jelly
· Materials needed to do Pap or other tests
Inspection
Purpose: Inspect hair distribution, and surface characteristics. Skin should be smooth and clean. Look for excoriation, rashes, lesions, discoloration or other signs of infection or inflammation.
Method:
Speculum examination
Purpose: The speculum is used to visualize the cervix and vaginal canal. The speculum should be lubricated. Select the appropriate size and gently insert finger of other hand just inside the vagina and apply pressure downward. When the patient is fully relaxed, insert gently and slightly downward. When properly in place the cervix should be fully exposed between the blades.
Method:
Palpation
Purpose: Insert gloved index and middle fingers into the vagina. Palpate the vaginal wall for cysts, nodules, masses or growths. Vagina should be smooth, homogeneous, and non-tender. *Make sure thumb is not touching the clitoris. Locate the cervix and feel for size, length and shape- should correspond with visual findings during speculum exam. Cervix should be movable 1-2cm with no discomfort.
Method:
Rectovaginal examination
Purpose: Place well lubricated index finger into the vagina and middle finger into the anus while having patient bear down. Palpate anterior rectal wall and rectovaginal septum for masses, polyps, nodules, sctrictures, irregularities and tenderness.
Method:
Bimanual examination
Purpose: With palmar surface of one hand on the abdomen and other inside vagina palpate fundus of the uterus between fingers of two hands at the level of the pubis. Palpate the uterus for position, size, mobility, tenderness, shape and contour. It should be pear-shaped, non-tender, smooth, firm and 5-8cm long.
Method:
Rectal examination
Purpose:
Method:
Different types of vaginal specula and their clinical application
A vaginal speculum consists of 2 blades and a handle. The speculum is used to view the vaginal canal and cervix. All of these specula are available in either disposable plastic or stainless steel reusable.
There are 3 basic types of vaginal specula:
1. Graves Speculum- Blades are curved with a space between closed blades
Available in a variety of sizes with blades ranging from
Bottom blade is 1⁄4 inch longer than top to conform to the longer posterior vaginal wall and aid in visualization.
- Pederson Speculumki
Has blades as long as those of Graves but are both narrower and flatter
Used for women with small vaginal openings - Pediatric or Virginal Speculum
Smaller in all dimensions
Short, narrow, flat blades
Normal appearance of the cervical os in a nulliparous and a parous patient
The cervical os in a nullip has a small, rounded appearance. In a parous patient the os appears as a slit. The transformation zone will vary depending on the age, use of estrogen and pregnancy.
Anteverted (anteflexed) uterus
Normal position of the uterus- fundus will be felt between two fingers at level of pubis.
Gravida/gravidity/para/parity
gravida/gravidity- Total number of pregnancies, regardless of outcome.
para/parity- Number of births over gestational age of 24 weeks. Alive or stillborn, does not account for multiples
Retroverted (retroflexed) uterus
Abnormal position of uterus- Uterus tilted toward coccyx. Palpate through rectocvaginal exam.
Multiparous / multigravida
More than 1 birth over gestational age of 24 weeks. Grand multip 4-6 births, great grand multip- >7 births
Corpus/ fundus/ cervix/ adnexa
corpus- body of uterus- includes fundus and isthmus- examined during bimanual exam
fundus- convex upper portion of uterus- extends to insertions of fallopian tubes. Fundal height is used to estimate stage of pregnancy
cervix- extends from Isthmus of uterus into vagina. Assessed during speculum exam. epithelial collection (pap smear) at cervical os.
adnexa- fallopian tubes an ovaries
Nulliparous/ nulliparity
AKA Nullip- has not carried a pregnancy to 24 weeks
Tanner stages for breast and pubic hair development in the female adolescent
See Diagram
Physical findings that may suggest a ‘reg flag’ for sexual abuse
Should be taken in consideration with history and behavior, never make assumptions:
* Signs of general physical Abuse or Neglect (Bruising, Malnourished)
* Evidence of trauma, scars in genital area
* Unusual changes in skin color in genitals
* Presence of STI, oral, anal, or genital
* Anorectal problems (anal itching, bleeding, pain, fecal incontinence, poor sphincter tone, bowel habit dysfunction)
* Genitourinary Problems(Rash or sore in genital areas, vaginal odor, discharge, pain, itching, bleeding, UTI)
Patient education regarding the pelvic examination and the genital self-exam
Recommend for anyone at risk for an STI, Instruct patient to wash hands before and after, position mirror so that pubic area is visible, inspect under hair for bumps, sores, blisters, and warts, spread vaginal lips and look at clitoral hood, clitoris, inspect inside of vaginal lips, urinary and vaginal openings, any abnormalities should be cause to seek healthcare provider
Cervical motion tenderness
during the bimanual exam, locate the cervix with the palmar surface of fingers. Grasp the cervix between your fingers and ,move it from side to side while watching the patient for any pain or discomfort. Pain suggests a pelvic inflammatory process.
Vaginal discharge
– during the external exam, while inspecting and palpating the labia minora, look for caking of discharge in the tissue folds, which suggests vaginal infection or poor hygiene. Discharge from the skene glands, bartholin glands, or urethra usually indicates infection.
Abnormal vaginal bleeding
abnormality in menstrual bleeding or inappropriate uterine bleeding are common gynecologic problems caused by a variety of issues (hormone changes throughout cycle, chronic PID, endometrial polyps, etc). In pregnancy, may have little consequences or may be life-threatening, and should be evaluated.
Cystocele
– a bladder hernia that protrudes into vagina
