GYNECOLOGIC EXAMINATION
The gynaecologic exam refers to the examination of a woman’s reproductive system, this includes examination of the abdomen and pelvic organs. However, many gynecologic problems have symptoms that involve other organ systems. The gynecologist should be ready to perform a general physical examination.
ABDOMINAL EXAMINATION
The standard techniques of auscultation, palpation, and percussion are used during an abdominal examination.
The examiner will note abdominal swelling, bruising, scars, stoma, hernia or any other visible external sign in the abdomen
Auscultation refers to the use of a stethoscope to listen to sounds from the abdomen. It aids in the assessment of abdominal sound and abdominal bruits.
Grumbling bowel sounds or high-pitched noises may indicate a bowel obstruction.
Diarrhea is associated with increased bowel sounds. If bowel sound is absent, it may indicate paralytic ileus or peritonitis
Palpation is typically performed twice, lightly and deeply.
During the light palpation, the examiner tests for palpable mass, pain, or rigidity
Rigidity may indicate peritoneal inflammation
On deep palpation, the examiner tests for enlargement of liver, spleen, gallbladder or kidneys.
During palpation, it is important for the examiner to be aware of the response of the patient’s abdominal muscles including watching their face for signs of discomfort.
Percussion can be very useful in revealing whether there’s abdominal levels of fluid in the abdomen
If an abdominal pelvis mass is discovered after a suprapubic examination, it is generally essential to note the characteristics, size, consistency (hard if fibroid or soft if it’s pregnancy), regularity and the presence of any tenderness.
PELVIC EXAMINATION
A pelvic exam is an inspection of the external and internal genital areas and an assessment of the health of the reproductive system and organs
The external genitalia is first inspected for normalcy of appearance and hair distribution.
The pubic hair is inspected for pubic lice and the pattern of hair growth
The labia majora is examined for ulcers, inflammation, warts, and rashes. Their position and symmetry are evaluated.
The labia minora are also inspected and presence of tearing, inflammation and swelling is noted
The opening of the uterus is also checked. No urine is expected to leak when patient coughs. Leaking may indicate stress or weakened pelvic structure
The vaginal opening is checked for position, presence of hymen, bruising, tearing and inflammation
If sexual abuse is suspected, questions should be directed to the patient after and not during the examination
The anus is checked for lesions, inflammation or trauma.
A speculum exam is used to assess the health of the vagina. The speculum is inserted to visualize the internal organs.
If it is the first pelvic exam of the patient, the examiner will show the patient the speculum, explain its use and answer any questions.
The cervix is inspected for lesion, polyps, and inflammation. The presence of any is noted.
Samples of the vaginal fluids may be taken to check acidity of the vagina, and screen for the sexually transmitted infections and other type of infections
Any vaginal discharge present is assessed for normalcy in color, consistency, and odor.
During speculum exam, a small spatula is inserted into the cervix and a sample of cervical cells is removed and sent to the lab for analysis to see if there are any abnormal cells which could indicate cancerous or precancerous changes
A bimanual examination is carried out after the speculum has been removed.
The uterus is evaluated and its size, mobility and position is noted.
It is abnormal for the examiner to feel the fallopian tube
The rectum is also checked and should be smooth.
Any developmental abnormalities discovered will be discussed.