pelvic examination

Modified by DrAmaal Rayan

To know the indication for pelvic examination

To know the technique and value of speculum

examination

To know the technique and value of bimanual

examination

To know how to do a pap smear and what is its

value

To know how to examine the vagina during labor

Check the health of the reproductive organs and to diagnose any problem

Prescribe andor fit birth control devices

Check for vaginal infections or STDs (sexual transmitted diseases)

Determine pregnancy or miscarriage

Screen for cervical cancer which can be treated and cured if found early

Routine checkup every year

Heavy vaginal discharge that itches burns or smells

Heavy vaginal bleeding or bleeding between periods

Painful intercourse

Menstrual cramps that cause you to miss school or work

Any signs of pregnancy

Side-effects of birth control

1-PV

Procedure before examination

1048707 Obtain her verbal consent

1048707 Explain that you are about to perform an internal examination of the vagina and the uterus using fingers

1048707 Explain to her that it shouldnt be painful and ask her to let you know if theres any pain

Procedures before examination

1048707 Ask her to empty bladder

1048707 Assure privacy and ask for a chaperone

1048707 Ask to lie on the couch and undress waist down 1048707 Sheet for dignity

1048707 Position her on back hips and knees flexed and thighs abducted

1048707 Examine abdomen for any mass and be sure bladder is empty

Examination 1- Inspect external genitalia 1048707 Hair distribution 1048707 warts

1048707 rashes

1048707 ulcers

1048707lumps 1048707 vesicles

1048707 excoriation

2- Examination

1048707 Ask the patient to cough

(urinary incontinence)

1048707 Ask the patient to bear down (uterine prolapse)

3-Gloves then palpate Urethral meatus Labia Bartholinrsquos glands

and Perineum 4- Lubricate the right index and middle fingers

1048707 5- Expose introitus by separating labia with thumb and forefinger of gloved left hand 10487076- Gently introduce gloved lubricated right index and middle fingers into vagina

1048707 7-Thumb abducted to allow maximum use of length of the index amp middle fingers ring amp little fingers flexed into palm

8- Palpation

Palpate anterior posterior and lateral walls of vagina

obliterated or bulging due to a pelvic swelling

mass cyst or foreign bodies

9-Examination of the cervix

Normally points downwards and slightlybackwards1048707Cervix should feel firm rounded and smooth

Assess mobility move cervix gently

Palpate the fornices

This procedure is painless

Tenderness is called ldquocervical excitationrdquo

Explain details of the procedure and gain verbal consent

Ask the patient to empty her bladder

Allocate a separate private area for the patient to undress

Chaperone should always be present

Gloves

Speculum

Lubricating jelly

Examination couch and a lsquomodesty sheetrsquo

Adequate lighting

Ensure speculum is warmed and all equipment is in working order

Hair distribution

Vulval skin

Look at the perineum for scarstears

Gently part labia ndash inspect urethra

Look for discharge prolapse ulcers warts

Inspect for

bullDischarge

bullWarts

bullTumours

bullSize of cervical os

bullBleeding

Ask the patient to cough Rectocele CystoceleLiquor

Women are invited to have routine smears performed every 1-3 years

Needs to be done in the mid-late follicular phase and NOT during menstruation

Worldwide- cancer cervix second most common malignancy

Following insertion of bivalve speculum

EquipmentAylesbury spatulaConfirm name hospital number etcLabel frosted end of slide

bullExplain that the procedure may be uncomfortable

Rest point of spatula within the os and rotate clockwise 360deg then rotate 360deg anti-clockwise

Exert light pressure (pencil)

Ensure contact with cervix throughout

Spread both sides of the spatula onto the slide

Place immediately into the fixative for between 10 ndash 90 mins

High-risk specimens should be left in for a minimum of 1 hour

Inform the patient how long the results will take and how they will be delivered

3-Bimanual examination

Separate labia with gloved left hand

Inserted index finger into vagina then slowly insert middle finger to palpate cervix

Left hand then palpates uterus abdominally

Tips of the vaginal fingers placed into each lateral fornix and the adnexae are examined on each side

The uterosacral ligaments can be felt in posterior fornix

4-Examination during labor

1 Palpate uterine contractions

2 Assessment of the cervix dilatation

bull 1 finger 1-2 cm dilated

bull 2 fingers 3-4 cms dilated


bull 4 fingers 7-10 cms dilates

3 Effacement of the cervix thinning of the cervix () or length (cm) The cervix is normally 3-5 cms If cervix is about 2 cm from external to internal os 50 effaced

50 effaced 100 effaced

4 Consistency of the cervix soft vs hard During labor the cervix becomes soft

5 Position of the cervix posterior vs anterior During labor the cervix changes from posterior to anterior

6 Membrane is intact or ruptured assessed by fluid collection in the vagina

objectives

Indications of pelvic exam

When to have a pelvic exam

PowerPoint Presentation

Preparation

Equipment

Inspection

Visualisation of Cervix

Findings

Taking a Cervical Smear

Indications of cervical smear

Taking a cervical smear( technique)

Taking a Cervical smear( technique)

Concluding Cervical Smear

Slide 27

Bimanual Examination

Slide 29

Slide 30

Examination during labor

Slide 32

Slide 33

Thank you

To know the indication for pelvic examination

To know the technique and value of speculum

examination

To know the technique and value of bimanual

examination

To know how to do a pap smear and what is its

value

To know how to examine the vagina during labor









Painful intercourse




1-PV












1048707 rashes

1048707 ulcers


1048707 excoriation

2- Examination








8- Palpation














Gloves

Speculum

Lubricating jelly


Adequate lighting


Hair distribution

Vulval skin




Inspect for

bullDischarge

bullWarts

bullTumours


bullBleeding

































objectives




Preparation

Equipment

Inspection


Findings






Slide 27


Slide 29

Slide 30


Slide 32

Slide 33

Thank you









Painful intercourse




1-PV












1048707 rashes

1048707 ulcers


1048707 excoriation

2- Examination








8- Palpation














Gloves

Speculum

Lubricating jelly


Adequate lighting


Hair distribution

Vulval skin




Inspect for

bullDischarge

bullWarts

bullTumours


bullBleeding

































objectives




Preparation

Equipment

Inspection


Findings






Slide 27


Slide 29

Slide 30


Slide 32

Slide 33

Thank you

1-PV












1048707 rashes

1048707 ulcers


1048707 excoriation

2- Examination








8- Palpation














Gloves

Speculum

Lubricating jelly


Adequate lighting


Hair distribution

Vulval skin




Inspect for

bullDischarge

bullWarts

bullTumours


bullBleeding

































objectives




Preparation

Equipment

Inspection


Findings






Slide 27


Slide 29

Slide 30


Slide 32

Slide 33

Thank you












1048707 rashes

1048707 ulcers


1048707 excoriation

2- Examination








8- Palpation














Gloves

Speculum

Lubricating jelly


Adequate lighting


Hair distribution

Vulval skin




Inspect for

bullDischarge

bullWarts

bullTumours


bullBleeding

































objectives




Preparation

Equipment

Inspection


Findings






Slide 27


Slide 29

Slide 30


Slide 32

Slide 33

Thank you

2- Examination








8- Palpation














Gloves

Speculum

Lubricating jelly


Adequate lighting


Hair distribution

Vulval skin




Inspect for

bullDischarge

bullWarts

bullTumours


bullBleeding

































objectives




Preparation

Equipment

Inspection


Findings






Slide 27


Slide 29

Slide 30


Slide 32

Slide 33

Thank you





8- Palpation














Gloves

Speculum

Lubricating jelly


Adequate lighting


Hair distribution

Vulval skin




Inspect for

bullDischarge

bullWarts

bullTumours


bullBleeding

































objectives




Preparation

Equipment

Inspection


Findings






Slide 27


Slide 29

Slide 30


Slide 32

Slide 33

Thank you











Gloves

Speculum

Lubricating jelly


Adequate lighting


Hair distribution

Vulval skin




Inspect for

bullDischarge

bullWarts

bullTumours


bullBleeding

































objectives




Preparation

Equipment

Inspection


Findings






Slide 27


Slide 29

Slide 30


Slide 32

Slide 33

Thank you

Hair distribution

Vulval skin




Inspect for

bullDischarge

bullWarts

bullTumours


bullBleeding

































objectives




Preparation

Equipment

Inspection


Findings






Slide 27


Slide 29

Slide 30


Slide 32

Slide 33

Thank you

Inspect for

bullDischarge

bullWarts

bullTumours


bullBleeding

































objectives




Preparation

Equipment

Inspection


Findings






Slide 27


Slide 29

Slide 30


Slide 32

Slide 33

Thank you

































objectives




Preparation

Equipment

Inspection


Findings






Slide 27


Slide 29

Slide 30


Slide 32

Slide 33

Thank you

pelvic examination

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