Chapter 17 Female Genitalia and the Pelvis
2 How can I make my patient as comfortable as possible during the pelvic exam?
By following a few simple steps:
Instruct her to void prior to the exam, since a full bladder can often be confused for a pregnant uterus or an ovarian cyst.
Ideally have her empty her bowels, too.
Raise the table back to a comfortable height so that you can maintain eye contact at all time.
Place a drape over her abdomen, thighs, and knees.
Before performing each step of the exam, inform her about it.
Instruct her to relax the perineal muscles through appropriate breathing.
Always wash your hands in the presence of the patient.
Warm the speculum before using it.
Watch your terminology during the exam. Never say you are going to “feel” something since this has sexual connotations. Use instead “check.” Also, do not refer to “foot rests” as “stirrups.” And more importantly, keep them out of sight until you are ready to use them.
Always explain your findings, even if normal.
Continuous communication is paramount. Provide your patient with a sense of control by reassuring her that she will be able to stop the exam at any time if it were to become too uncomfortable. Also, offer her a hand-held mirror so that she can become more of a participant. By following these guidelines, pelvic exams should cause minimal discomfort or embarrassment. They should never be painful, except for tenderness from underlying pathology.
7 What are the tools needed for a pelvic exam?
Padded exam table with padded foot rests (quilted oven mitts do nicely)
Good and adjustable light source (gooseneck or fiberoptic lamp)
Plastic (or metal) vaginal specula of various sizes and types, including Pedersen’s, Graves’, and pediatric
Although a simple direct exam can provide lots of information, a few bedside diagnostic procedures are routinely added. These include occult blood testing, microbiologic assessment, and performance of the Papanicolaou smear (which provides a simple cytologic exam for cervical inflammation, atypia, or dysplasia). To carry out these procedures you will need:
A. Inspection/Palpation of External Genitalia: Vulva and Perineum
15 What are Tanner’s stages of sexual maturation?
They are a way to assess sexual maturation by following the growth of breast and pubic hair. They are mostly used in pediatric and adolescent medicine, but also can be helpful in evaluating patients with primary amenorrhea (Table 17-1).
18 What are the benign white lesions of the vulva?
They are mostly vitiligo and inflammatory dermatitis, like psoriasis.
20 What are malignant white lesions?
Mostly two: vulvar intraepithelial neoplasia and Bowen’s disease.