Pelvic examination Flashcards
Preferred position?
Supine, with legs in dorsal lithotomy position
Why the bed should be elevated 30 degrees?
To relax abdominal wall muscles for bimanual examination
What is said to the woman?
- She may stop or pause the examination at any time
- Each part of the evaluation is announced or described before its performance
- Ask her to empty the bladder!
- *An assistant/nurse (woman) is recommended during the pelvic examination**
Which lymph nodes should be palpated during pelvic examination?
Inguinal lymph nodes => Pelvic cancers may drain to these nodes
Which types of speculum are available? And what are their indications?
- Paediatric: Child, adolescent or virginal adult
- Graves: Parous women with relaxed and collapsing vaginal walls
- Pederson: Sexually active women with adequate vaginal tone
Recommendations for the prior use of especulum?
- Speculum may be warmed with running water or warming lights
- Lubrication may add confort to insertion
Why lubricants should not be used during citology?
- Actually, GEL (water-based) lubricants did NOT increase unsatisfactory Pap smear citology rates or decrease Chlamydia trachomatis detection rates => If used, should be a dime-sized aliquot applied to the speculum blades
- If there are no gel lubricants, water may be used too
What should be done before insertion of speculum?
- Labia minori should be separated
* Urethra identified => Because of urethral sensitivity, the speculum is inserted well below the meatus
Which manoeuvre can be helpful during the insertion of speculum in women undergoing first examination, infrequent coitus, dyspareunia, or heightened anxiety?
*Prior to speculum placement:
**An index finger may be placed in the vagina, and pressure placed posteriorly.
**The woman is then encouraged to relax this posterior wall to improve comfort with speculum insertion
==> The idea is NOT to make a great force on the posterior wall to allow the insertion, but to let the woman know what to relax!
REMEMBER ALWAYS to describe the woman the procedures. Like this one, before trying. Just look at how she do it: YouTube: The Pelvic Exam - Stanford Medicine 25
Describe the technique for speculum insertion
- Position the speculum oblique to the vagina and insert
- After the insertion, the vagina commonly contracts, and the woman may note discomfort, a pause at this point typically is followed by vaginal muscle relaxation
- While inserting the speculum rotate it until completely the blocking mechanism facing down
- Once it is completely inserted, angle approximately 30 degress downwards to reach the cervix
- Open the speculum
- *When taking the speculum out remember to close it once it is all out, or slowly.
Most common position of uterus?
Anteverted, it is also commonly that is flexed: Anteflexed
What should be looked for once the speculum is inserted? (3)
- Masses
- Ulceration
- Discharge
How is interpreted the bleeding during/after Pap test (after the swabs, etc)?
- If it is a small bleeding should not worry the patient, it is especially normal in nuliparous women
- If there is a deal of quantity once one is doing the swab, one can think of a cervicitis due to some infection, specially if it is accompanied by a discharge of fluid
What is assessed during bimanual examination?
Uterine and adnexal size, mobility and tenderness
During the bimanual examination how is known if the uterus is anteverted or retroverted?
- Once the cervix is reached, uterine orientation can be quickly assessed by sweping the index finger along the ventral*** surface of the cervix:
- *Anteverted position: The uterus isthmus is noted to sweep upward
- *Retroverted position: A soft bladder is palpated
- **if it is done in the dorsal surface: In a retroverted uterus the isthmus is felt sweep downward
