Speculum Examination

Question 1

What is the following clinical sign and what does it indicate?

Answer 1

cervical os: if open, this may indicate an inevitable or incomplete miscarriage.

Question 2

What is the following clinical sign and what does it indicate?

Answer 2

erosions around the os: most commonly associated with ectropion however early cervical cancer can have similar appearances.

Question 3

What is Cervical ectropion?

Answer 3

Cervical ectropion is a condition in which the columnar epithelial cells which are normally located inside the cervical canal are present on the outside of the vaginal cervix (normally the only cells on the outside of the vaginal cervix are squamous epithelial cells). The areas of columnar epithelial cells appear red against the normal pink colour of the cervix and are often located around the external os. They are more prone to bleeding, due to the presence of a network of delicate fine blood vessels, and as a result, patients often present with post-coital bleeding.

Question 4

What is Cervical cancer?

Answer 4

Cervical cancer

Cervical cancer is caused by persistent infection with human papillomavirus (HPV). Prior to the development of cervical cancer, the cells of the cervix can become dysplastic, a condition that is known as cervical intraepithelial neoplasia (CIN). Cervical screening can identify patients infected with HPV and those who have gone on to develop CIN, allowing early treatment to prevent progression to invasive cervical cancer. Many women do not have symptoms in the early stages of cervical cancer, but symptoms can include vaginal bleeding (intermenstrual, post-coital), increased vaginal discharge and vaginal discomfort. Clinical examination typically reveals white or red patches on the cervix in early disease or the presence of a cervical ulcer or tumour in more advanced disease.

Question 5

What are Further assessments and investigations will you do?

Answer 5

Further assessments and investigations

Urinalysis: including β-HCG to rule out pregnancy (e.g. ectopic pregnancy).

Vaginal swabs/endocervical swabs: if there are concerns about infection (bacterial/viral).

Complete abdominal examination: if there are concerns about intraabdominal pathology (e.g. appendicitis).

Ultrasound abdomen and pelvis: to further investigate pelvic pathology.

HPV testing: if there are concerns about cervical cancer.