Gynaecological and Genital examination

1. Gynaecological Case Taking
Pelvic Examination
Digital & Per Scapulum
DR. RAMVEER SHARMA
M.D. Ayu.(PT&SR)
PROF.& H.O.D.
Prasuti Tantra & Stree Roga Dep't.
M.M.M .Govt. Ayu. College UDAIPUR
Mob. 9414757932
Email. ramveersharma1960@gmail.com
DR. RAMVEER SHARMA
Per Scapulum Examination

2. THE PELVIC EXAMINATION
Indications :-
 All Gynecological cases for diagnosis,
 Cases with - Genital pathology
- Developmental or congenital
• - Acquired =Traumatic
- Infection
Before vaginal medication & surgery
-Douching, Swabbing, & Therapeutics,
Routine during pregnancy- to Diagnosis & assessment of
pregnancy conditions. DR. RAMVEER SHARMA
Per Scapulum Examination

3. Contra Indications
During menstrual period.
Sever (acute type) pelvic infections
Contact bleeding with clotting defect –
 Cervical erosions
 Cervical carcinoma.
Acute vaginal, cervical, uterine injuries and Infections.
H / O Antenatal hemorrhage (APH), Habitual abortion.
DR. RAMVEER SHARMA
Per Scapulum Examination

4. Pre- Requisites
a. A female attendant or nurse, her husband should be present.
b. Doctor should explain to patient or her guardian, what is he
going to do.
c. Examine to minor/ unmarried - consent from the parent or
guardian should be required.
d. Bladder and Rectum should preferably be empty by herself
or by catheterization and enema.
e. Sterilized - Equipments and Solutions must be readily
available.
DR. RAMVEER SHARMA
Per Scapulum Examination

5. Required Equipments & Solutions
1.Good light source (Shadow less),
2.Sterile gloves (Proper size)
3.Sterile colorless lubricants,
4.Sponge holding forceps.
5.Speculum required type with anterior vaginal wall retractor
(sterilized & on body temperature)
6.Swabs cotton and bandage.
7.Solutions -Formalin, Normal Saline, Fixing and Staining etc.
8.Cytology brush, Spatula (ayre )
9.Slides and cover slips culture tubes.
DR. RAMVEER SHARMA
Per Scapulum Examination

6. Position of the Patient :-
The position of the patient is depend on the –
• Place/space of examination table
• Required examination and other procedures,
• Choice of doctor - Dorsal, Sims, Left lateral, Lithotomy,
Knee chest, Flat on back with complete abducted thigh and
knee.
 Physician should stand on her right side.
DR. RAMVEER SHARMA
Per Scapulum Examination

7. Dorsal Position
Lie on her back, knee flexed, thighs slightly abducted,
buttocks on the edge of the table.
DR. RAMVEER SHARMA
Per Scapulum Examination

8. Left Lateral Position
Patient lie on her left and drawn up both knee.
DR. RAMVEER SHARMA
Per Scapulum Examination

9. Sim’s Position
Patient lies on her left side with - Left arm behind her
The right knee slightly drawn up more than the left.
DR. RAMVEER SHARMA
Per Scapulum Examination

10. Lithotomy Position
This position is most suitable for vaginal procedures under
General Anesthesia.
 Patient lies on her back,
 Buttocks drawn at the edge of the table and Thighs flexed.
 Knee slightly abducted, legs held supported by foot piece or
crutch.
DR. RAMVEER SHARMA
Per Scapulum Examination

11. DR. RAMVEER SHARMA
Per Scapulum Examination

12. I) External Genitalia:-
A) Inspection:-
1) Mons pubis
• Prominent/ no prominent?
• Skin color- red / black / white
(dermatitis) etc.
• Hair distribution – Feminine/ male type.
DR. RAMVEER SHARMA
Per Scapulum Examination

13. I) External Genitalia:-
2) Labia Majora:-
• Prominent / non prominent.
• Skin color- red / black / etc.
• Swelling/ lump/ scar or wound.
DR. RAMVEER SHARMA
Per Scapulum Examination

14. 3) Labia minora :-
Color – Pink - Normal
• Reddish - Infection inflammation?
• White – Moniliasis or Leucoplakia?
• Any sour/ irruption/ wound.
DR. RAMVEER SHARMA
Per Scapulum Examination

15. 4) Clitoris:-
• Size- Normal - 1-2.5 cm.
• Enlarged – Adrenogenitalism.
• Shape – Cylindrical like penis.
• Color – Like labia minora.
DR. RAMVEER SHARMA
Per Scapulum Examination

16. 5) Vulva –
• Any –discharge
• Growth - Small warts,
• Condylomata,
• Papillary growth, due to infection of HPV.
• Any scar/ oedema ?
• Varicose veins.
DR. RAMVEER SHARMA
Per Scapulum Examination

17. 6) Vestibule :-
 Expose the vestibular bulb by separate the labia minora with
left hand index finger and thumb.
• Any swelling, malformation, mal development.
 Urethral opening:- Red – Urethritis ?
• Carbuncle
• Prolapsed, Carcinoma,
• Any discharge- purulent/ blood stained.
• On strain – discharge of urine
DR. RAMVEER SHARMA
Per Scapulum Examination

18. Bartholin’s glands:-
• Expose the vestibule watch underneath labia Majora.
 Opening :- Red colour – Bartholinitis,
Any discharge – Pus – Gonorrhea.
Vaginal orifice –
Hymen:- Intact – virgins,
Bulged – Imperforate hymen,
Rigid / Ruptured.
7) Anus:- Look for hemorrhoids/ anal fissure or fistula and
growth.
8) Perineum:- Any scar of episiotomy / rupture.
DR. RAMVEER SHARMA
Per Scapulum Examination

19. 9) The Vagina:- The vagina is inspected by speculum so called
 Speculum examination.
• Sequence - The speculum examination is done prior to
bimanual examination.
Advantage:- of first P.S.
• The samples - Cervical scrape cytology / Endocervical
sampling / Vaginal discharge can be collect on a single sitting
for hystopathological examination.
DR. RAMVEER SHARMA
Per Scapulum Examination

20. Insertion of speculum:-
Sim’s speculum – is one of the best because it allows wide
area visualization as well as anterior wall of vagina also.
Cusco’s speculum is best use for cervical inspection and
sample collection & medication.
DR. RAMVEER SHARMA
Per Scapulum Examination

21. Steps:-
1. Speculum should sterilize and warmed at body temperature ,
lubricate with colorless jelly.
2. Get the proper and suitable position to the patient.
3. Separate the labia minora and expose the introitus - by index
finger and thumb of left hand.
DR. RAMVEER SHARMA
Per Scapulum Examination

22. Steps:-
4. Speculum introduce gently ( without showing to the patient )
by -
 Right hand up to 2/3 strait {with blades closed in bivalve}
 and rotate to 90 degree and then insert the anterior vaginal
wall retractor.{open the blades of bivalve}.
 Fixed the self retaining speculum by fixation screw or by
assistant.
DR. RAMVEER SHARMA
Per Scapulum Examination

23. Watch and Note:-
• Vaginal wall-
Color - Pink – Normal.
 Red or bluish - Infection / Inflammation/ Pregnancy.
 Brown or white – Leucoplakia
 Adherent of any discharge or plaque.
DR. RAMVEER SHARMA
Per Scapulum Examination

24. Watch and Note:-
 Any growth like cyst or tumours /or septum.
 Any prolapse Cystocele/ Rectocele uterine etc.
• Fornix - Colour/ Growth/ Discharge.
DR. RAMVEER SHARMA
Per Scapulum Examination

25. Vaginal walls Monilial Vaginitis
DR. RAMVEER SHARMA
Per Scapulum Examination

26. Vaginal wall Trichomonal Vaginitis
DR. RAMVEER SHARMA
Per Scapulum Examination

27. Vaginal wall In Gonorrhoea and senile Vaginitis
DR. RAMVEER SHARMA
Per Scapulum Examination

28. Cervix:- Portio vaginalis –
Colour –
 Pink - Normal
 Red or bluish – Pregnancy / Hyperplasia
(Inflammation, Infection)
 White or blackish – Leucoplakia / Carcinoma.
 Adherent any discharge – Purulent / Pus / Blood.
DR. RAMVEER SHARMA
Per Scapulum Examination

29. Cervicitis
DR. RAMVEER SHARMA
Per Scapulum Examination

30. Appearance of Cervical dysplasia
DR. RAMVEER SHARMA
Per Scapulum Examination

31. Cervical Polyp
DR. RAMVEER SHARMA
Per Scapulum Examination

32. Size & Shape -
 Conical with pin hole - Hypo plastic uterus
 Barrel shape oedimatous - Cervicitis
 Any lesion of cervical tears,
 Erosion,
 Ectropion,
 Polyps,
 Carcinoma.
 External os –
Round - Nulliparous and slit in multiparae, any discharge.
DR. RAMVEER SHARMA
Per Scapulum Examination

33. COLLECTION OF THE SAMPLE
 Endo cervical sample – by Cyto brush.
 Vaginal fornix sample – by Pipette.
 Cervical scrapping – Ayer's wood or plastic spatula.
 Whole of the squamocolumnar junction has to be scraped,
clock wise 380º.
DR. RAMVEER SHARMA
Per Scapulum Examination

34. DR. RAMVEER SHARMA
Per Scapulum Examination

35. DR. RAMVEER SHARMA
Per Scapulum Examination

36. Per Scapulum Examination