General Examination Introduction and smile! General examination of hands and mucous membranes Supra-clavicular lymph nodes should be felt Thyroid gland should be palpated Chest & Breasts Proceed with abdominal and pelvic examination
Preparation Explain details of the procedure and gain verbal consent Ask the patient to empty her bladder & remove any sanitary protection. Allocate a separate private area for the patient to undress. Chaperone should always be present.
Equipment Gloves Speculum Lubricating jelly Examination couch and a modesty sheet Adequate lighting Ensure speculum is warmed and all equipment is in working order
Positioning Patient should be supine. Place heels together with knees bent & allow legs to fall apart. The light should be adjusted to allow a good view of the vulva and perineum.
Inspection Hair distribution Vulval skin Look at the perineum for scars/tears Gently part labia – inspect urethra Look for discharge, prolapse, ulcers, warts
Insertion Hold speculum so blades are orientated in direction of vaginal opening Part the labia and slowly insert, rotating the speculum until its blades are horizontal
Visualisation of Cervix Inspect for: Discharge Warts Tumours Size of cervical os Bleeding
Univalve Speculum Positioning Position patient in the left lateral position Knees drawn up to chest Hold back anterior vaginal wall with lubricated speculum
Findings Ask the patient to cough: Rectocele Cystocele Liquor
Taking a Cervical Smear
When and why? Women are invited to have routine smears performed every 1-3 years Needs to be done in the mid-late follicular phase and NOT during menstruation Worldwide- Ca Cx second most common malignancy
Taking a cervical smear Following insertion of bivalve speculum Equipment: Aylesbury spatula Confirm name, DOB, hosp number etc Label frosted end of slide Explain that the procedure may be uncomfortable
Taking a Cervical smear Rest point of spatula within the os and rotate clockwise 360° then rotate 360° anti-clockwise. Exert light pressure (pencil). Ensure contact with cervix throughout.
Concluding Cervical Smear Spread both sides of the spatula onto the slide. Place immediately into the fixative for between 10 – 90 mins. High-risk specimens should be left in for a minimum of 1 hour. Inform the patient how long the results will take and how they will be delivered.
What do the results mean? Normal- means you have very low chance of developing ca of the cx but not 100% guarantee) Inadequate- no true result can be given as inadequate sample. Repeat smear indicated Abnormal- minor changes are quite common, repeat smear 3-12 months advised
Bimanual Examination Separate labia with gloved left hand Inserted index finger into vagina then slowly insert middle finger to palpate cervix Left hand then palpates uterus abdominally
Tips of the vaginal fingers placed into each lateral fornix and the adnexae are examined on each side The uterosacral ligaments can be felt in posterior fornix