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Pelvic Exam

Overview :

The first part of the examination involves visual inspection and palpation of the external genitalia. The examiner will note the characteristics of the labia majora, labia minora, clitoris, urethral orifice, and the Skene's and Bartholin's glands. In addition, the perineum and anus will be checked. The clinician will be examining these areas for any indication of swelling, inflammation, abnormal discharge, polyps, abnormal odor, or other lesions.

The next part involves examining the internal genitalia. The examiner will first insert a gloved finger into the vagina in order to palpate the cervix. Next an instrument called a speculum is inserted. This device is made of plastic or metal and used to open the vaginal cavity in order for the examiner to be able to view the vaginal walls and cervix. Any lesions, bleeding, or abnormal discharge can be visualized with the speculum in place. If indicated, a Pap smear will then be performed. With the speculum still in place, the examiner gently scrapes the patient's cervix with a wooden or plastic spatula as well as a cylindrical-type brush. The spatula collects cells from the outer surface of the cervix, while the brush is used to collect cells from the inner-cervix. The collected cells are then spread on a glass slide, sprayed with a fixative, and sent to a laboratory for analysis. The examiner may then insert a cotton or Dacron swab into the cervix. This will be held in place for 10-30 seconds and when withdrawn spread on a plastic plate or into a tube containing a reagent for the specimen. This procedure may be repeated again with the anus. Such swab tests are used to check for gonorrhea and chlamydia, or bacterial vaginitis, which is a bacterial infection resulting in inflammation of the vagina.

Following the Pap smear is the bimanual examination during which the examiner will place an index and middle finger into the vagina to first examine the vaginal walls for any irregularities or tenderness. The cervix will then be palpated in order to note its shape, consistency, mobility, and any tenderness. The examiner will then place his or her other hand on the abdomen and gently push down while pushing the cervix up. This is done to assess the size and shape of the uterus, and also to note any tenderness or abnormal lesions. During this time, the ovaries are also checked for any masses, or tenderness.

The last part of the pelvic exam is the rectovaginal examination. This allows the clinician to better examine the pelvic organs and structures. The examiner will place their index finger into the vagina and a lubricated, gloved middle finger against the anus. During this part, the patient may feel an urgency to have a bowel movement. However, this is a natural feeling and a bowel movement will not occur. The patient will then be asked to strain down in order for the anal sphincter to relax. As relaxation occurs the examiner will insert the middle finger into the rectum, enabling the position and shape of the uterus to be better assessed. In addition, any masses or tenderness can be evaluated at this point. The anal canal and rectum can also be examined for any polyps, or other lesions at this time. After the rectovaginal exam, the patient will be allowed clean off any excess lubricant and get dressed. The examiner will then discuss the procedure and any findings with the patient.

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