Who should get a pelvic exam and how often?
First exam - women at age 21 , every 3 years after.
Unless other health concerns.
Important issues related to the pelvic exam.
Cultural issues Patient modesty Anxiety about the exam History of rape or abuse Office environment
Pelvic exam: Office environment concerns
have an additional person in the exam room while assessing reproductive organs, explain what you are doing, ensure comfort and modesty.
Pelvic exam: patient comfort/modesty
gowns and sterile drapes, foot of table does not face the door, door marked to avoid interuption, allow patient to wear socks, bra or sweater.
3 parts of the pelvic exam
Speculum exam
Bimanual exam
Recto-vaginal exam
3 parts prior to beginning gloved examination
History Inspect -pubic hair -lymph nodes -urethral meatus -orifices Palpate -labia -milk skene's and bartholin's glands -perineum
Speculum exam
1st exam.
performed without lubricant, speculum warmed and closed when inserted at 45 degree angle posteriorly
Visual observation of cervix
position color surface characteristics discharge shape/size of os
The Papanicolaou [pap] exam
minimum 2 samples taken
- cervical cells
- vaginalsecretion
-STD tests possible
3 most common STDs among women
HPV, Herpes, Chlamydia
- QC (2nd highest in IA
- in women often no symptoms
Goal of pap smear
Screen for cervical cancer, assessing the transition zone of cervix
Accuracy of pap smear
- Decreased cervical CA death rate by 75%
- False-positives (10-40%)
- False-negatives (1-15%)
vulvovaginitis
due to bacteria, viruses, fungi, protozoans.
symptomatic discharge
itching, burning, color change, texture or odor of discharge
Bimanual exam
2nd exam
- evaluate cervix, uterus, adenexal regions
- PID, endometriosis
- important for even those who are not sexually active
Recto-vaginal exam
3rd exam
allows exam of rectal walls, evaluates the posterios aspect of uterus
Uterine fibroids
risk factors
- nulliparity
- african american (2-3x)
- older age
benign
40% OF WOMEN OVER 40
-MC pelvic tumor
-MC reason for hysterectomy
x-rays - cauliflower-like
Symptoms/treatment of Uterine Fibroids (leiomyoma)
heavy menstrual bleeding abdominal distortion pelvic pressure low back pain dyspareunia infertility frequent urination constipation miscarriage or premature labor
wait and see
hysterectomy
drug therapy
Endometriosis
“condition of inner layer”
normal endometrium found in abnormal places
risk factors
-25-44 years (10-15%)
Signs and symptoms
- PAIN, PAIN, PAIN
- pelvic mass
- alterations of menses
- dysmenorrhea
- infertility
- dyspareunia
- pain with defecation,urination
early onset of menses
short cycle (<27days)
severe menstrual cramps
prolonged flow (>1 week)