Makindo Medical Notes

Related Subjects: | Causes of Abnormal Vaginal Bleeding | Vaginal Carcinoma | Cervical Cancer | Endometrial (Uterine) Cancer | Post Menopausal Bleeding | Anatomy of the Uterus | Anatomy of the Ovary | Gynaecological History Taking | Gynaecological Examination (OSCE) | Colposcopy | Premature Menopause | Polycystic Ovary Syndrome

Begin by introducing yourself and explaining your role to the patient. Ensure the patient understands the procedure of the pelvic exam, including what it involves and why it is necessary. Obtain explicit verbal consent and emphasize that the patient can stop the procedure at any time if they feel uncomfortable or in pain. Offer to answer any questions the patient may have.

General Examination

• Assess whether the patient appears well or unwell. Look for signs of distress, discomfort, or anxiety.
• If the patient appears unwell, prioritize the ABCs (Airway, Breathing, Circulation) and address any immediate medical concerns.

Abdominal Examination

• Inspection: Look for any visible abnormalities on the abdomen, such as scars, distension, discoloration, or visible masses.
• Palpation: Feel the abdomen for tenderness, rigidity, or signs of peritonitis (e.g., guarding, rigidity, or rebound tenderness).
  • If a mass is detected, consider the possibility of pregnancy or other masses (e.g., fibroids, ovarian cysts).
  • If the abdomen is distended, percuss to check for ascites (fluid accumulation) or bowel obstruction.
• Auscultation: Use a stethoscope to listen for bowel sounds, which can provide information about intestinal activity.

Vaginal Examination

• Vulva Inspection: Look for signs of abnormality or irritation, such as lesions, redness, swelling, or discharge.
• Speculum Examination: Use a speculum to examine the vagina and cervix.
  • Position the patient on their back with knees bent and feet in stirrups or in the left lateral position (ideal for detecting prolapse).
  • Explain each step of the process to the patient before proceeding to ensure they are comfortable.
  • For prolapse or incontinence, use a Sims’ speculum to inspect the vaginal walls more effectively.
• Bimanual Examination: With one hand on the patient's abdomen and two fingers of the other hand in the vagina, feel the uterus and ovaries for size, shape, mobility, and tenderness.

Using a Cusco's Speculum

• Lubricate the speculum with jelly (unless performing a cervical smear, then use warm water to avoid affecting the sample).
• Insert the speculum closed, with blades parallel to the labia, and direct it towards the sacrum at a 45-degree angle.
• Rotate the speculum, open the blades, and the cervix should come into view. If not, perform a bimanual examination to check the position of the cervix and try again.
• Take swabs and perform a cervical smear if required. Ensure samples are labeled correctly.
• Close the speculum gradually under direct vision as you withdraw it to avoid trapping the cervix and causing discomfort.

End of Examination

• Thank the patient for their cooperation and reassure them about the procedure.
• Ensure the patient is comfortable and offer assistance if needed, such as helping them to sit up, providing tissues, or allowing them to change in privacy.
• Provide information about the next steps, including any follow-up appointments or further investigations if necessary. Address any questions or concerns the patient may have, and offer written information or resources if available.