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Gynecological History Taking

and Examination
Oleh:
Analia

Preceptor:
Dr. Dino R, Sp.OG (K)
History taking
Personal data

Current problem

Micturition

Bowel habit

Menstrual history
History taking
Past obstetric history

Past gynecological history

Sexual history

Medical history

Family history
• Gynecological exam chair,
washing basin & soap, light
source, clean specula, clean
gloves, lubricant, microscope,
Equipment needed slides, swabs.
• Additional: dissecting forceps,
cervical biopsy forceps, manual
vacuum aspiration, cyto brush,
fixation agent

• Lock the door, put sign of no entry without


permission, explain what are you goin to
Privacy do.
• If you are a male provider, you should have
one other female.

General exam • Nutritional status, vital sign


Abdominal Palpation
Ask to empty the bladder and lie down

• Inspect for surgical scar, abdominal distention or visible tumor

Ausculate if you suspect the bowel obstruction

• Percuss all four quadran

Palpate the area below umbilicus, try to find out if there area
where deep palpation is not possible due to pain or if you can
feel any hard or soft resistance.
Speculum exam
Before speculum exam, inspect the
You should consider not doing a
vulva: normal development of external
speculum exam if the patient is a
genital, hirsutism, skin lesion, scars,
virgin
discharge, swelling, prolapse

Lithotomy position, bladder should be Two common types of specula:


empty, and speculum should be warm bivalve speculum, anterior and
and lubricated posterior wall speculum

Identify the cervix and asses its color, smoothness and shine,
any disruption of the surface? Any reddishness or whitishness?
Any discharge or pus? Specifically look for the polip, tumor,
ulcerations, condyloma, squamocolumnar junction. Inspect the
vaginal wall for tumor, ulceration, change of color, discharge
and fistula. Take swab for wet mount and IVA.
How to insert bivalve spekulum:
For removal close the
valves a bit but not
Wear clean gloves completely

If you insert the spuculum


too far you might enter the
posterior fornix behind the
Direct light cervix and load the cervix
up on your anterior valve

Insert closed speculum, if


Separate the labia you need more space push
minor with two the perineum down gently,
fingers rotate so the valves become
horizontal
Wet Mount
take some discharge from the posterior
vaginal fornix

Put it on microscope slide. Add one or two


drops of normal saline and put cover slide
on top

Use magnification 10x first and identify the


polygonal vaginal epithelium cells. Turn to
40 and examine closely.

A normal wet mount shows the epitelium


cells, leukocytes and lactobacilli.
Wet mount
Clue cell

Trichomonas

Sperm cell

Yeast
Bimanual Vaginal Palpation
• Asses the pelvic organ and any abnormal mass
between your right hand internally in the vagina
and your left externally on the lower abdomen,
patient should be in lithotomy, explain what you
are planning to do

• How to do: insert index and middle finger of right


hand in the vagina, avoid touching the external
urethral orifici and use jelly or water to avoid
friction. Place the left hand on the lower
abdomen above the symphsis and palpate with
your finger.
Bimanual vaginal palpation
1. Cervix
- Excitation 2. Uterus 3. Adnexa
tenderness - Axis - Size
- Consistency - Size - Tenderness
- Mobility - Consistency - Mobility
- External os
Rectovaginal examination
• In cases with suspect malignancy, endometriosis or any process
located in the pouch of douglas.
• Leave right index finger in the vagina and right middle finger in the
rectum, use jelly to lubricate. Keep the left hand on the abdomen
above the symphisis.
• Feel for the smoothness and regularity of the surface. A disruption
of the surface, tumor, ulceration can be a malignancy or
endometriosis penetrating the rectum from the pouch of douglas.
• Gently pressing index and middle finger can asess the tissue
between rectum and vagina.
• Induration or enlargemnet of this area can be endometriosis or
cervical/uterine or rectal malignancy.
• Asses the broad ligament by gently pushing your two finger
upwards against your left hand. Palpate for induration and
enlargemnet . This point to advanced stage cervical or uterine
malignancy.
Examination of the breast
Lymph node
Inspection Breast palpation
palpation
• Symmetry • Cervical • Palpate from
• Location • Supraclavicular cranial-caudal
• Visible tumor • Infraclavicular or periphery to
center
• Skin changes • Axillar
• Finish by
• Skin reaction • Parasternal
palpating the
areola and
check for nipple
discharge