GYNAECOLOGIC EXAMINATION

Prof Hamonangan Hutapea

Bag Obstetri & Ginekologi
FK USU
Medan
GINECOLOGIC EXAMINATION
An accurate and complete history takings is of
the prime important.
Ask what the main problem is.
Ginecological patients may be shy or
embarassed and require :
* Privacy,
* Time,
* Sympathy and,
* Empathy.
 Gynecological Examination
GIO.
Understand and able to do ginecological examination
systematically and can draw a right and good conclution
there after.
SIO.
1.Take a relevant history.
2.Doing General Examination correctly.
3.Explain the rectal and rectovaginal examination.
4.Understand the necessity of supporting me-
dical equipments and laboratory investigations for a
better diagnosis.
 Hystory Takings
Previous gynecological or other illness & treatments.
Menstrual history: may vary very much from patient
to patient. Menarche is the age of the first onset of
menstruation(10 16) yrs. Rhythm/regularity of the
cycle and blood flow(expressed as:5/28) the normal
cycle:(21-35) days and the bleeding lasts for(3-9)
days. Volume of blood loss (30-80)ml.Remember that
every 80ml loss would mean a loss of about
40 mg elemental iron.
Molumina: a secondary effects of menstrual
cycle,with discomfort,irritability,depression,breast
discomfort,backache,pelvic pain which is not severe
enough that the patient can keep her normal
activities and,
Last Menstrual Period(LMP).
 History Takings
Obstetric History: parities,puerperal
infection,infertility and abortion.
General History: Previous diseases:
cardiac or endocrine disease, diabetes,
liver, kidneys, tuberkulosis
or psychiatric illness.
Previous surgical prosedure especially
ginecological should be noted.
 Complaints of pain
Pain: the location,type,intermittent,related to
menstr.cycle.The ordinary pain location is felt in
the back,lower abdomen and down to the
thighs(remember the pain of appendicitis).
The severity of pain can be judged to some
extent by its effect on the patient`s behaviour.
Rupture of the ectopic pregnancy,torsion of an
ovarian cyst produces intense,continuous pain.
 Examination of the breast
The patient should be seated or lying on
her back.
The breast should be palpated
thoroughly,included axilla.
Note the colostrum or blood expressed
from the nipple.
A palpated lump may suggest malignancy.
(Routine mammography is offered every
3yrs in women 50-65 yrs of age).
 Abdominal Examination
Abdominal palpation is mandatory.
The correct tecnique of:
inspection,palpation, percussion and
auscultation is advised.
Palpation should be done gentelly on a
relaxed abdomen with the whole surface
of your palms to detect tenderness,cystic
or solid gynecologic tumors.
 Abdominal Examination
Inspection of a large ovarian cyst reveal a
characteristic of a rounded,symmetrical
abdomen,with streched skin and a fluid
thrill may be elicited(no shifting dullness)
The ascites or malignant ovarian tumor
with ascites shows the shifting dullness on
abdominal percussion,flat abdomen,and
an umbilical protrution.
 Examination of the vulva
External and internal genitalia of a female
patient can be examined thoroughly on a
gynecological chair,in a confort and
suitable room.
Dorsal position is most covenient for most
patient and doctor.
 Examination of Vulva
A single finger is inserted into the vagina.Palpate
the condition of:Labia,clitoris,anus and the
surroundings skin.
Skin conditions: irritant discharge and
pruritus,purplish discolorationdiabetes?
Observe:urethral meatus,squeeze any pus from
the periurethral-glands, and palpate the
bartholins glands.
If possible insert two fingers,and palpate the
perineal floor.
 Bimanual Pelvic Examination
A formal consent is essential before
examination(by medical student).
Customarily two fingers is inserted into the
vagina,and external hand on the lower
abdomen to collect and supplies information.
Very few information gained if the patient finds
the examination painful.
In a virgin or a child rectal examination should
be carried out.
This technique needs practice.
 Bimanual Pelvic Examination
Palpate the cervix,note any hardness.
The whole uterus is identified,the
size,shape,position,mobility and
tenderness are noted.
The lateral pelvic is palpated and any
swellings should be noted.
Rectovaginal examination is sometimes
informative and helpful.
 Speculum Examination
Speculum examination should be done
before vaginal examination.
The equipment used: Bivalve speculum
made of steel(Cusco speculum)or of
plastic (disposable),Sims speculum and
Fergussons speculum are also available.
Avoid excessive amounts of lubricant.
 Materials and equipments
1. Surgical Gloves
2. Bivalve speculum, Vergussons swpeculum and
Sims speculum
3 Sponge forceps(to clean cervix and vagina)
4. Metal catheter and,Rubber/plastic catheter
5. Sublimated cotton ball
6. Object glass for citologic examination of
vaginal swap/smear.
 7.. Ayre spatel and ethyl alcohol 95% for
cervical and vaginal cytology.
8.. Cotton ball tipped straw for the exami-
nation of Gonorhoe,trichomonas and
candidas.
9.. Chemical solution:
(Sod,chloride,potassium hydroxide)
for fresh preparation of vaginal secrete.
10.. Cervix tennaculum.
11.. Uterine sound.
12.. Biopsy forcep.
13.. Micro curett or vacume needle biopsy.
14.. Etc.
THANK YOU
7. Ayre spatula.

8. Cotton tipped stick to prepare fresh vaginal preparation.

9. Saline solution and Potassium hydroxide solution to test the presen-
ce of Trichomonas or Candidas in a fresh vaginal preparation.
10. Cervix Tenaculum

11. Uterine Sound

12. Biopsy forceps

13. Micro curet

14. Etc.