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

Introduction

Begin the examination by introducing yourself and explaining your role to the patient. Ensure that the patient understands what is going to happen during the pelvic exam. Obtain explicit verbal consent from the patient and emphasize that they can stop the procedure at any time if they feel uncomfortable or in pain.

Step 1: General Examination

• Start by assessing whether the patient appears well or unwell. If the patient appears unwell, prioritize starting with the ABCs (Airway, Breathing, Circulation).

Step 2: Abdominal Examination

• Inspect the abdomen for any visible abnormalities.
• Palpate the abdomen for tenderness or peritonism.
• If a mass is detected, consider the possibility of pregnancy.
• If the abdomen is distended, percuss to assess for ascites.

Step 3: Vaginal Examination

• Inspect the vulva for signs of abnormality or irritation.
• Use a speculum to examine the vagina and cervix. Position the patient either on their back or in the left lateral position (ideal for detecting prolapse).
• For prolapse or incontinence, use a Sims’ speculum, which has two right-angle bends, to inspect the vaginal walls.

Step 4: Using a Cusco's Speculum

• Use a Cusco's (bivalve) speculum to inspect the cervix. Lubricate the speculum with jelly unless performing a cervical smear, in which case warm water should be used.
• Insert the speculum closed, with blades parallel to the labia, and direct it towards the sacrum.
• Rotate the speculum, open the blades, and typically the cervix will 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.
• Close the speculum gradually under direct vision as you withdraw it to avoid trapping the cervix.

Step 5: End of Examination

• Thank the patient for their cooperation.
• Ensure the patient is comfortable and offer assistance if needed.
• Provide the patient with information about the next steps, including any follow-up or further investigations, if necessary.