gynecologic pelvic examination

15.11.2014

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Tevfik Yoldemir, MD, BBA

Marmara University Department of Obstetrics and GynecologyDivision of Reproductive Endocrinology and

Infertility

PELVIC EXAM

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PositioningPositioning

�� Move the pillow down to her headMove the pillow down to her head

�� Help her place her heels into the stirrupsHelp her place her heels into the stirrups

�� Buttocks are on the edge of the tableButtocks are on the edge of the table

�� Ask her to relax her legs to the sideAsk her to relax her legs to the side

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Lithotomy PositionLithotomy Position


External GenitaliaExternal Genitalia

�� Mons pubisMons pubis

�� Tanner’s pubic hair distributionTanner’s pubic hair distribution

�� Excoriations or papules (lice)Excoriations or papules (lice)

�� Labia minora and majoraLabia minora and majora

�� Bartholin’s glandsBartholin’s glands

�� InflammationInflammation

�� UlcerationUlceration

�� NodulesNodules

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External GenitaliaExternal Genitalia

�� ClitorisClitoris�� Clitoromegaly: Enlarged clitorisClitoromegaly: Enlarged clitoris

�� Milk urethraMilk urethra�� Urethral diverticulumUrethral diverticulum

�� Periurethral glandsPeriurethral glands

�� UrethritisUrethritis

�� HymenHymen

�� Perineal bodyPerineal body

�� ScarsScars

�� AnusAnus�� External hemorrhoidsExternal hemorrhoids

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BARTHOLIN’S CYSTBARTHOLIN’S CYST

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Gynecologic ExamGynecologic Exam

�� Separate the labia:Separate the labia:

�� Ask the patient to coughAsk the patient to cough

�� Supine stress testSupine stress test

�� Ask the patient to bear downAsk the patient to bear down

�� CystocoeleCystocoele

�� RectocoeleRectocoele


Vaginal ExamVaginal Exam

�� Warm the speculumWarm the speculum

�� Lubricate the speculum with water or gelLubricate the speculum with water or gel

�� Good lightingGood lighting

�� Have supplies for Pap smear and culturesHave supplies for Pap smear and cultures

�� Use the correct size of speculumUse the correct size of speculum

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Inserting the speculumInserting the speculum

�� Choose the right sizeChoose the right size

�� Lubricate the speculumLubricate the speculum

�� Separate the labia with your other handSeparate the labia with your other hand

�� Avoid the urethraAvoid the urethra

�� Angle the speculum downwardAngle the speculum downward

�� Open the speculum when fully inserted to Open the speculum when fully inserted to

visualize the cervixvisualize the cervix

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Inspect the cervixInspect the cervix

�� Squamocolumnar junctionSquamocolumnar junction

�� ColorColor

�� UlcerationsUlcerations

�� MassesMasses

�� BleedingBleeding

�� DischargeDischarge

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Normal CervixNormal Cervix

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Cervical EctopyCervical Ectopy

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Papanicolaou smearPapanicolaou smear

�� Spatula: Put the longer end in the os and turn Spatula: Put the longer end in the os and turn

360 degrees360 degrees

�� Cervical brush: Insert into the os and turn 360 Cervical brush: Insert into the os and turn 360

degreesdegrees

�� Smear the slide and immediately use a Smear the slide and immediately use a

fixativefixative

�� Obtain cultures from cervix and swab from Obtain cultures from cervix and swab from

posterior fornixposterior fornix

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�� As you withdraw the speculum, open it As you withdraw the speculum, open it

slightly to avoid pulling on the cervixslightly to avoid pulling on the cervix

�� Observe all four walls of the vaginaObserve all four walls of the vagina

�� DischargeDischarge

�� UlcersUlcers

�� MassesMasses

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Bimanual ExamBimanual Exam

�� Lubricate the index and middle fingersLubricate the index and middle fingers

�� Insert your fingers pressing posteriorlyInsert your fingers pressing posteriorly

�� Palpate the vaginal fornicesPalpate the vaginal fornices

�� Palpate the cervixPalpate the cervix

�� PositionPosition

�� ShapeShape

�� Motion tendernessMotion tenderness

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Bimanual ExamBimanual Exam

�� Palpate the uterusPalpate the uterus

�� Place your other Place your other hand on the hand on the abdomen above abdomen above the pubic the pubic symphysissymphysis�� SizeSize

�� ShapeShape

�� TendernessTenderness

�� MassesMasses

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Bimanual ExamBimanual Exam�� Palpate the ovariesPalpate the ovaries

�� Place your vaginal Place your vaginal hand to the side of hand to the side of the cervix, your the cervix, your opposite hand in the opposite hand in the same side lower same side lower

abdominal quadrantabdominal quadrant�� SizeSize

�� ConsistencyConsistency

�� TendernessTenderness

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Rectovaginal ExamRectovaginal Exam

�� Change gloves Change gloves

�� Lubricate your fingersLubricate your fingers

�� Insert the index finger into Insert the index finger into the vagina and the middle the vagina and the middle finger into the rectumfinger into the rectum

�� Ask the patient to bear Ask the patient to bear downdown

�� Palpate the posterior cervixPalpate the posterior cervix

�� Palpate the uterosacral Palpate the uterosacral ligamentsligaments

�� Palpate the rectovaginal Palpate the rectovaginal septumseptum

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Complete the examComplete the exam

�� Offer her a washcloth to remove the Offer her a washcloth to remove the

lubricantlubricant

�� Help her to a sitting positionHelp her to a sitting position

�� Explain the findings and the tests Explain the findings and the tests

performedperformed

gynecologic pelvic examination

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