PD E3- Female GU Exam

What is the shape of the external os in nulliparous patients?

Round or oval

What is the shape of the external os after childbirth?

Slit like or stellate

What are periurethral glands that lie on either side of urethral meatus?

Skene’s glands

What condition is characterized by severe & painful menstrual cramps?

Dysmenorrhea

What are pockets made by folded vaginal wall surrounding the cervix?

Fornix

In what patients are rugae absent from the vagina?

Children & postmenopausal

What is the position of the body of the uterus?

Almost at right angle with vaginal wall, inclined slightly forward over bladder

Fundus is the domed superior area

What is the extension of the peritoneum off the superior surface of the uterus and on the anterior face of the rectum that is reachable on rectal exam?

Pouch of Douglas / retrouterine pouch / cul-de-sac

What has in utero DES exposure been linked to?

Mother: breast CA

Females: vaginal adenosine, cervical hood, clear cell carcinoma

Males: cryptorchidism, hypospadias, testicular cancer

What are patient responsibilities before a PAP smear/ GU exam?

Avoid intercourse 24-48 hrs before exam, empty bladder before, try to relax abdominal and vaginal muscles, & no lubricants, vaginal inserts, or douching before exam

How should the patient be positioned for GU exam?

Drape mid abdomen to knees & depress drape between knees so patient can see you, dont place arms overhead bc can tense abdominal muscles

What are advantages to plastic speculums?

Easy to view vaginal walls, already warm, more comfort, easier to use one handed, disposable

What are disadvantages to plastic speculums?

not cost effective, more trash, not as sturdy, not easy to use on obese patients, pinches patient

What are advantages to metal speculums?

Cost effective, sturdy, more comfortable when warm

What are disadvantages to metal speculums?

Patients alarmed at metal clicking sound, not easy to use one hand, need an autoclave and alot of sets / time to clean

What kind of speculum?

• small introitus

• virginal (Huffman is best)

• elderly women

• various sizes → small is size of regular tampon but longer than pediatric speculum

Pedersen speculum

What speculum?

• wider speculum

• obese patients

• sexually active women

• multiparous

• large size may be necessary in some

Graves speculum

What glands are responsible for vaginal lubrication, located at 5 & 7 o’clock at introitus?

*obstruction will lead to pain, enlargement, and discharge

Bartholin’s glands

What types of hernias are more common in women?

*palpate in labia majora, go upward just lateral of pubic tubercles

Indirect inguinal / femoral

If a uterus is retroverted, what direction does the cervix typically point?

Anteriorly

What are endocervical glands on the cervix that become filled with secretions that accumulate as pimple-like elevations (benign)?

Nabothian cysts

How should the speculum be withdrawn from the introitus?

Close slowly & keep it slightly open, close as it emerges from introitus & rotate 90° counterclockwise; put pressure on posterior introitus, avoid pinching or excessive stretching

PAP smear guidelines

What checks for abnormal cells (dysplasia) and cancerous cells on the cervix & checks the endocervical canal?

*checks for cervical cancer only, not uterine

Pap smear (Papanicolaou)

How do you perform a Pap smear (papanicolaou)?

Insert brush into os & gently twist → remove brush & swab into specimen collection cup

Insert long end of spatula into os & turn it 360° → remove into collection cup & send to lab

Gonorrhea and chalmydia cultures are taken from the _______

Cervix

BV, trich, and candida swabs are taken from the _____

Vagina

What tests should be performed on vaginal discharge?

pH, wet mount & KOH analysis

What area of the cervix should you obtain the specimen when performing a Pap smear?

Transformation zone

What does cervical ectropion (eversion) indicate in menstruating women?

Normal

What does cervical ectropion (eversion) in postmenopausal women indicate?

Ominous finding, requires consideration of cervical CA

How do you palpate the uterus?

Place off hand on abdomen → elevate cervix with 2 fingers of right hand → grasp uterus between 2 hands → feel for size, masses, & tenderness

How do you palpate the ovaries?

Abdominal hand on R/L lower quadrant & pelvic hand in corresponding fornix → press in and down on abdomen → gently roll hands back and forth to capture ovary

What will you feel on a bimanual exam if an infection is deposited along the vaginal wall or a tubo-ovarian abscess is present?

*d/t fallopian tubes opening into abdominal cavity

Enlarged tender mass on lateral vaginal wall

What is the uterine position?

Version → uterus

Flexion → body / top

How do you palpate a retroverted uterus?

Rectovaginal exam: Place index finger in vagina & middle finger in rectum → push down abdominal hand and top of uterine fundus will tap your finger in the rectum

When is a rectovaginal exam performed?

Colon cancer, incontinence, rectocele, cul-de-sac tumors, infx suspected

How do you perform rectovaginal exam?

Insert index finger into vagina & middle finger into rectum (insert only when you feel sphincter fatigue) → have pt bear down and palpate septum and posterior fornix (scissor fingers to feel for tumors) → rotate middle finger 360°

Which cancer does the Pap smear rule out?

Cervical cancer

What does an ovary > 1-3 cm suggest?

Cysts or cancer