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Urogynecological examination (EXAMINATION (EXTERNAL FEMALE SEX ORGANS…
Urogynecological examination
Urinary incontinence
symptoms:
Urinary incontinence, bladder storage, sensory symptoms, voiding and postmicturition symptoms
Pelvic Organ Prolapse (POP)
Sexual dysfunction symptoms
Anorectal dysfunctions
Lower urinary tract pain, pelvic pain
Lower urinary tract infections
examination:
Frequency volume chart/Bladder diary
Pad test different durations from a short (1 hr) test to a 24- and 48-hr tests
Urine analysis, urine culture
Residual urine volume determination. Volumes greater than 50-100 mL are abnormal.
Urogynecological examination (to assess the stuctures and function of the pelvic floor)
Stress testing generally is performed with a full bladder and the patient in the standing position. A positive test result consists of urinary leakage directly observed from the urethral meatus (cough test, Valsalva)
Pelvic Examination
Vulval examination
Urethral inspection/palpation
Vaginal examination
Bimanual pelvic examination
Pelvic floor muscle function
Examination for levator (puborectalis) injury
Perineal examination
Rectal examination
Physical examination: Cotton swab test
Urodynamic studies:
Uroflowmetry
Cystometry
Urethral pressure profilometr
Pelvic Organ Prolapse examination:
Baden-Walker System, Pelvic Organ Prolapse Quantification (POP-Q): Stage 0: No prolapse is demonstrated.
Stage I: Most distal portion of the prolapse is more than 1 cm above the level of the hymen.
Stage II: Most distal portion of the prolapse is 1 cm or less proximal to or distal to the plane of the hymen.
Stage III: The most distal portion of the prolapse is more than 1 cm below the plane of the hymen.
Stage IV: Complete eversion of the total length of the lower genital tract is demonstrated.
introduction
identyfy a patient
introduce yourself
MEDICAL INTERVIEW
Ask the patient if she has any problems or confirms.
bladder should be clear before examination
easier to physician to examine patient and more comfortable for patient.
EXAMINATION
abdominal examination (scars, pubic hair distribution, palpation-assess for denderness and enlargement of intraabdominal organs; ascites)
gynaecological examination (with speculum, bimanual examination)
transvaginal ultrasound, transabdominal ultrasound examination
speculum examination, examine with vaginal speculum (we can lubricate speculum), during examination we reveal vagina and cervix
EXTERNAL FEMALE SEX ORGANS
mons pubis-describe pubic hair distribution, look for skin lesions, discolouration, excoloration, lice, ulcers, abscesses
labia majora-covered with pubic hair, they meet anteriorly as the mons pubis
labia minora-medial to labia majora, no pubic hair, they meet anterioly to cover the clitoris, enlargement of Bartholin’s glands
perineum-area bethween the fourchette and the anus (labia minora meet posteriorly at fourchette), inspect for lesions, scars; high before labor
the introitus (opening of vagina), separate labias to expose it, hymenal ring
clitoris –size, trauma, ulcers
older women- ask to cough to demonstrate urinary incontinence or uretro-vaginal prolapse
Internal exam
SPECULUM EXAMINATION
to locate the external cervical os and vaginal part of cervix.
Examination for foreign bodies and cervical swabs are taken at this point in the exam (PAP Test).
Separate labias with the index finger and thumb of the left hand
Insert closed (lubricated) speculum trough the introitus (vestibule) into the vaginal canal in following way:
closed speculum inserted vertically with speculum handles on patient right side, rotate handles through 90 degrees, insert ¾ of length of speculum to vaginal canal. Pushing handles together opens the blades of speculum and visualise vaginal part of cervix.
Vaginal canal- vaginal mucosa
CERVIX INSPECTION
cervical os : nulliparous- small, round; multiparous- transverse slit
secretions/ discharge –colour, smell
ulcerations, polyps, scars, retencion cysts (Nabothian follicles), cervical ectopion
pap smear
BIMANUAL EXAMINATION
palpate size, morbility, consistency, shape and position of the uterus and ovaries and detect tenderness or pathology
Gently separate labia with index finger and thumb of left hand. Two fingers (index and middle finger) of the right (internal) hand insert into the vagina until they isolate/ locate the cervix. The examiner presses down on the abdomen with the external (left) hand, to locate the fundus of the uterus and the adnexal structures.