Abnormal Pelvic Exam by mikeholy

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									Abnormal Female Pelvic Exam


            Steven Swift MD
   Professor Department of Obstetrics
   and Gynecology Medical University
             South Carolina
Components of a female pelvic
          exam

 Visual inspection of external genitalia.
 Speculum exam to visualize the cervix
  and vagina.
 Bimanual exam with 2 fingers placed in
  the vagina and the other hand on the
  abdomen.
     Why Perform a Female
         Pelvic Exam?
   Cervical cancer prevention through pap
    smears.
   Visualize the external genitalia,cervix and
    vagina for abnormalities.
   Identify structural abnormalities of the
    internal pelvic organs.
   Identify the source of pelvic pain.
   Confirm normalcy.
Inspection of External Genitalia
   Visual identify the labia minora, labia
    majorum, urethral meatus and
    perineum.
    – Identify any mucosal abnormalities, or
      anatomic defects.
    – Identify infectious dz and congenital
      anomalies.
Female external genital exam
    Herpes Simplex
     appears as small
     painful vesicles on
     the labia and
     vestibule.
Female external genital exam
    Condyloma appear
     as painless verucous
     lesions on the vulva
Female external genital exam
    A Bartholin’s gland
     abscess.
     – typically exquisitely
       painful
     – Can occur as a
       sequela of pelvic
       inflamatory dz.
Hematocolpos secondary to an
    imperforate hymen
          Speculum exam
   Visualize the cervix and perform a Pap
    smear.
    – Pap smears detect premalignant changes
      in the cervical cytology that are invisible to
      the naked eye.
    – Pap smears should be performed annually
      in all women over the age of 21 yrs or 3
      years after the onset of coitus.
    Female Speculum Exam
   Normal appearance
    of the cervix
   Pap smear involves
    sampling the ecto-
    and endocervix.
          Speculum exam
   Allows visual inspection of the cervix
    and vagina for evidence of anatomic
    pathology or infection.
    – Polyps or ulcers
    – Leukorrhea
    – Vaginal discharge
Endocervical polyps
    Female Speculum Exam
   Luekorrhea
    – gross pus coming
      from the cervical os
    – Uterus is generally
      exquisitely tender
    – Associated with
      pelvic inflammatory
      disease
    Female Speculum Exam
   Trichomonas
    vaginosis
    – A sexually
      transmitted dz of the
      vagina.
    – Few symptoms
      except vaginal
      discharge.
          Bimanual exam
   Performed by placing 2 fingers placed in
    the vagina and the other hand on the
    lower abdomen.
    – The uterus, ovaries a fallopian tubes are
      palpated between the 2 hands.
   Structural abnormalities and pain can
    be defined and apperciated.
    – Often difficult to localize the abnormality
            Bimanual Exam
   Leiomyomata (or
    fibroids) are a common
    anatomic abnormality.
   Fibroids can usually be
    easily palpated.
   Can be assymptomatic
    or present with
    abnormal bleeding
    patterns.
           Bimanual Exam
   Hydrosalpinx can be
    palpated as a lateral
    cystic mass.
   Can be tender if
    infection is active.
           Bimanual exam
   Paratubal cyst can
    be palpated as a
    large cystic lateral
    mass.
   Generally non-
    tender
            Bimanual Exam
   Ovarian cystadenoma
    can be felt as a large
    non-tender lateral
    mass.
   Can be malignant as a
    cystadenocarcinoma.
   Can not reliably
    differentiate benign
    from malignant on
    bimanual exam.
      Large ovarian tumors
   Cystoadenomas
    can be very large
    distorting the
    abdomen.
   These tend to be
    benign.
           Bimanual Exam
   Solid ovarian
    tumors.
    – palpated as solid
      lateral structures.
   Easily confused with
    fibroids.
   Can not reliably
    differentiate benign
    from malignant on
    bimanual exam.
        Bimanual Exam
 The final component is the recto-
  vaginal exam.
 Done with 1 finger in the rectum and
  the second in the vagina.
 Structures in the cul-de-sac and distal
  rectum can be palpated.
 Controversial as to when it should be
  initiated.
       Bimanual exam
 The bladder and urethra can also be
  palpated for tenderness and anatomic
  anomalies.
 Some large and small bowel processes
  can be appreciated on bimanual exam
  but are best diagnosed with other
  modalities.
                Summary
   The female pelvic exam is important in
    evaluating for pain, infection and anatomic
    abnormalities of the female GU system.
   It is also used to screen for premalignant disease
    of the cervix.
   It can not reliably distinguish between benign
    and malignant conditions of the uterus and
    ovary.

								
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