GYNECOLOGIC

EXAMINATION
Prof Hamonangan Hutapea SpOG.K
Departement of Obstetrics and Gynecology
Medical School USU
Medan.

GYNECOLOGIC
EXAMINATION

An accurate and complete history taking is of most

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 medical equipments and laboratory investigations for
a better diagnosis.

History Taking

Previous gynecological or other treatments.

Menstrual history: may vary very much from
patient to patient. Menarche is the age of
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 (3080/200)ml.Remember that every 80ml loss
would mean a loss of about 40 mg 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 Taking

Obstetric History: parities,puerperal

infection,infertility and abortion.
General History: has the patient ever
suffered from any diseases: cardiac
or endocrine disease,diabetes,liver,
kidneys, or tuberkulosis or
psychiatric illness. Previous surgical
prosedure especially ginecological
should be noted.

Complaint of pains

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:
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
breasts

The patient should be seated or lying

on her back.
The breast should be thoroughly
palpated,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 tecnique of
inspection,palpation, percussion
and auscultation is advised.
Palpation should be done gently on
a relaxed abdomen with the whole
surface of your palms to detect
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 woman can be examined
thoroughly on a gynecological
chair,in a fully lighted, confort
and suitable room.
Dorsal position is covenient for
most patients and doctors.

Examination of the
Vulva

An index finger 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.

Speculum Examination

Speculum examination should be done

first before vaginal examination.
The instrument 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.

Bimanual Pelvic
Examination

A formal consent is essential before

examination(by medical student).
Customarily two fingers is inserted into the
vagina,and external hand is on the lower
abdomen to collect and supplies sensasional
information.Very few information gained if
the patient finds the examination painful.
In a virgin or a child, rectal examination is
advised.
Bimanual Examination 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 noted.
Rectovaginal examination is
sometimes very helpful.

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 for
vaginal swap/smear.

7.. Ayre spatel and ethyl alcohol 95% for

cervical and vaginal cytology.
8.. Cotton ball tipped straw for the examination 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 presence of Trichomonas or Candidas in a fresh vaginal preparation.
10. Cervix Tenaculum
11. Uterine Sound
12. Biopsy forceps
13. Micro curet
14. Etc.