Examination and Diagnostic procedures of the Female Reproductive Health…
Examination and Diagnostic procedures of the Female Reproductive
During the pelvic examination, a Pap smear is obtained by rotating a small spatula at the os, followed by a cervical brush rotated
in the os. The tissue obtained is spread on a glass slide and sprayed
or fixed immediately, or inserted into a liquid. A small broom-like
device can also be used to obtain specimens for the Pap smear.
A specimen of any purulent material appearing at os is obtained for culture. A sterile applicator is used to obtain the
specimen, which is immediately placed in an medium
for transfer to a laboratory
BIO MANUAL PALPATION
To complete the pelvic examination, the examiner performs a biomanual examination from a standing position. The examination
is performed with the forefinger and middle finger of the gloved
and lubricated hand. These fingers are placed in the vaginal the thumb completely adducted. The fingers are advanced vertically along the vaginal canal, and the vaginal wall is palpated.
The cervix is palpated and assessed for its consistency, mobility,
size, and position. The normal cervix is uniformly firm but not
hard. Softening of the cervix is a finding in early pregnancy.
Hardness and immobility of the cervix may reflect invasion by a
neoplasm. Pain on gentle movement of the cervix is called a positive chandelier sign or positive cervical motion tenderness
(recorded as +CMT) and usually indicates a pelvic infection.
Next, the right and left adnexal areas are palpated to evaluate the
fallopian tubes and ovaries. The fingers of the hand examining
the pelvis are moved first to one side, then to the other, while the
hand palpating the abdominal area is moved correspondingly to
either side of the abdomen and downward. The adnexa (ovaries
and fallopian tubes) are trapped between the two hands and palpated for an obvious mass, tenderness, and mobility. Commonly,
the ovaries are slightly tender, and the patient is informed that
slight discomfort on palpation is normal.
VAGINAL AND RECTAL PALPATION
Bimanual palpation of the vagina and cul-de-sac is accomplished
by placing the index finger in the vagina and the middle finger in
the rectum. To prevent cross-contamination between the vaginal
and rectal orifices, the examiner puts on new gloves. A gentle
movement of these fingers toward each other compresses the posterior vaginal wall and the anterior rectal wall and assists the examiner in identifying the integrity of these structures. During this
procedure, the patient may sense an urge to defecate. The nurse
assures the patient that this is unlikely to occur. Ongoing explanations are prov
To palpate the uterus, the examiner places the opposite hand on
the abdominal wall halfway between the umbilicus and the pubis
and presses firmly toward the vagina (Fig. 46-5). Movement of
the abdominal wall causes the body of the uterus to descend, and
the pear-shaped organ becomes freely movable between the abdominal examining hand and the fingers of the pelvic examining
hand. Uterine size, mobility, and contour can be estimated through
palpation. Fixation of the uterus in the pelvis may be a sign of
endometriosis or malignancy.
The body of the uterus is normally twice the diameter and
CYTOLOGIC TEST FOR CANCER
The Pap smear is performed to detect cervical cancer. Before
1940, cervical cancer was the most common cause of cancer death
in women. Dr. George Papanicolaou discovered the value of examining exfoliated cells for malignancy in the 1930s. Due to the
effectiveness of the Pap smear as a screening method, cervical cancer is now less common than breast or ovarian cancer.
COLPOSCOPY AND CERVICAL BIOPSY
All suspicious Pap smears should be evaluated by colposcopy. The
colposcope is a portable microscope (magnification from 10× to
25×) that allows the examiner to visualize the cervix and obtain a
sample of abnormal tissue for analysis. Nurse practitioners and
gynecologists require special training in this diagnostic techniqu
CRYOTHERAPY AND LASER THERAPY
Cryotherapy (freezing cervical tissue with nitrous oxide) and laser
treatment are used in the outpatient setting. Cryotherapy may result in cramping and occasional feelings of faintness (vasovagal