SKILL LABORATORY PRACTICE MODULE

BLOCK : REPRODUCTIVE SYSTEM

MODULE : 1
TOPIC : Dermatovenereology Examination

I. GENERAL OBJECTIVE
After completing this the students will be able to perform Female Venereology
Examination

II. SPECIFIC OBJECTIVE

At the end of skill practice, the student will be able to demonstrate female
venereological examination and collecting specimen of under the following
framework:

a. Initiating the Session

 Establishing initial rapport
 Identifying the reason for the consultation
b. Gathering Information
 Exploration of patient’s problems
 Additional skills for understanding the patient’s perspectives
 Encourages patient to express feeling
c. Providing structure for the consultation
 Making organization overt
 Attending to flow
d. Building relationship-facilitating patient involvement
 Using appropriate non verbal behaviour
 Developing rapport
 Involving the patient
e. Closing the session

III. METHODE
 Presentation
 Coaching
 Self practice

IV. EQUIPMENT
 Audiovisual aids
 Learning guide

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 V. COURSE STUDY GUIDE HISTORY TAKING AND VENEREOLOGICAL EXAMINATION

No. TOPIC SUBTOPIC LEARNING METHODE INSTRUCTOR MEDIA REFERENCE

OBJECTIVE
1. Sexually Venereological TLWBA to perform a Presentation Rasmia,dr.SpKK - learning Graney DO,Vontver LA. Anatomy and
physical examination of female genital
Transmitted examination venereological Coaching Oki,dr.MKes. guide
tract. In: Holmes KK, Sparling PF, Mardh
Infection Examination Self practice SpKK(K) - audiovisual PA, Lemon SM, Stamm WE, Ipot P,
Wasserheit JN ede. Sexually Transmitted
Yunita aids
Diseases. 3rd ed., New York: McGraw-Hill
D,dr,SpKK - Ana - Inc.,1999:685-90.
tomical
Curtis JL, Holmes KK. Individual-level
model risk assessment for STD/AIDS infections.
In: Holmes KK, Sparling PF, Mardh PA,
Lemon SM, Stamm WE, Ipot P,
Wasserheit JN ede. Sexually Transmitted
Diseases. 3rd ed., New York: McGraw-Hill
Inc.,1999: 678-79

Arya OP.History taking, examination of

patient, collection of specimens and
common presenting symptoms. In: Arya
OP, Hart CA eds. Sexually Transmitted
Infection and AIDS in The Tropic. New
York: CABI Publ., 1998: 43-9.

Bickley LS. Bates’ Guide to physical

examination and history taking. 9th ed.
Philadelphia:Lippincott William&Wilkin
Co.,2007:432-448
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 VI. LEARNING GUIDE VENEREOLOGICAL EXAMINATIONS

PERFORMANCE
No. PROCEDURE SCALE
0 1 2
CLIENT ASSESSMENT
01. The patient should be given adequate explanation about the
examination (purpose, procedure)
02. Ask the patient to urinate before examination.
03. Ask permission before the examination be carried out.
Ask the patient to take off her under wear, then lay down in
lithotomy position on the examining table
04. Wash your hands and dry with clean dry towel, then put on the
gloves.

GROIN & PUBIC: examiner in stand up position

05. Inspect and palpate the inguinal region for the presence of
lymphadenopathy. If presence, note the number, size,
consistency, mobility and tenderness.
06. Inspect the pubic skin for any lesion. At the pubic hair, are
there any lice or nits?

VULVA & URETHRA : examiner in sitting position

07. Inspect the labia majora & minora for any lesions: erythema,
edema, fissures, papules, vesicles, erosions and ulcers.
08. The labia minora are separated. If there are any discharge
coming from the introitus, note for amount, color and
consistency.
09. Inspect the urethra and periurethra (Skene’s gland) for
erythema, edema or other lesions and discharge. If discharge
is presence, note the amount, color and consistency. If there is
no discharge, urethra is milked by gentle pressure by
forefinger from above downward.
10. Palpate the Bartholin’s gland at 5 and 7 o’clock direction on the
face of posterior fourchette between thumb and forefinger. If
infected, the gland may be tender and pus may be seen at
inflamed duct orifice.

VAGINA & CERVIX: examiner in sitting position

11.  Wipe the introitus vagina with a moist sterile gauze
 Enlarge the introitus with applying downward pressure
with index finger of left hand at lower margin while the
right hand inserting the speculum that already been
lubricated at 30°, then slide it inward along the posterior
wall of the vagina.
 Rotate the speculum into horizontal position, then insert
to it full length.
 Open the speculum carefully. Rotate and adjust it until it
cup the cervix and visualized well. Maintain the open

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 position of the speculum by tightening the thumb screw.
12. Inspect the vaginal wall for the presence of erythema,
discharge or other lesions such as: papules, vesicles,
erosions, ulcers. If discharge is presence, note the amount,
color and consistency.
13. The external ostium of the cervix is wiped clean to remove
mucus using forcep with gauze or cotton wool.
14. Inspect the exocervix for the presence of erythema, ectopy,
discharge, and lesions such as papules, vesicles, erosions,
ulcers. If discharge is presence, note the amount, color and
consistency.
SPECIMEN COLLECTION : examiner in sitting position
15. Neisseria gonorrhoeae :
 Insert a cotton-tipped swab about 2 cm into the cervical
canal. Rotate the swab gently for 5 – 10 second to allow
absorption of the exudates. Smear thinly the specimen
on a microscopic slide for the Gram staining (look for
PMN cell and Gram negative intra celular diplococcus
(ICDC))
 Second swab is done with the same way and placed into
transport medium for culture.
16. Chlamydia trachomatis :
Insert a chlamidya specimen collecting swab 2 cm into the
cervical canal and rotate it for 10 second, gently scrap epithelial
cells from the surface. After that, place the specimen into the
transport medium for antigen/nucleic acid detection.
17 Clue cell:
Insert other swab into introitus vagina. Swab the vaginal wall,
put it to the microscopic slide for Gram staining, and look for the
Clue cells. (Microscopic interpretation: Positive if clue cell >
20% of epithelials per high power field)
18 Candida sp.:
 Prepare a microscopic slide first which already been add
drop of 10% potassium hydroxide.
 Insert other cotton-tipped swab to vaginal wall, and put it
on the slide and cover with cover slip. (Microscopic
intepretation: Look for pseudohyphae, budding cell)

19 Trichomonas vaginalis:
 Prepare a microscopic slide first which already been add
drop of saline.
Insert other cotton-tipped swab to the posterior vaginal fornix,
and put it on the slide and cover with cover slip (Microscopic
intepretation: Look for the motion of Trichomonas vaginalis)
pH DETERMINATION OF VAGINAL FLUID
20. Hold the pH paper with forcep, then apply it to the vaginal wall
near the lateral fornix for a while. Pull it out and measure the
acidity of vaginal fluid by comparison with a standardized color
scale.

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WHIFF TEST/AMINE TEST
21.  Remove the speculum gently.
 Add a drop of 10% potassium hydroxide to vaginal fluid
pooling at the speculum.
 The test is positive if smell of “fishy odour”.
 Pull the speculum and put it in the basin filled with
decontamination solution.

BIMANUAL EXAMINATION (CERVICAL MOTION TENDERNESS): examiner in stand

up position
22.  Lubricate the index and middle finger of one of your
gloved hand.
 Insert both the index and middle finger into the vagina, to
the finger clamps the cervix and another hand
compressed the suprapubic.
 Move the finger that clamps the cervix, noting the
tenderness. Normally the cervix can be moved without
pain.

PERIANAL: examiner in sitting position

23. The buttocks should then be separated for inspection of
perianal region for any lesions and discharge. If there are any
discharge, collect the specimen and do the same procedure.

CLOSING
24. Tell to the patient that the examination is finish and ask her to
get dressed. All of the examination result is written to the
medical record and fill the laboratory form.