Gynecology Examination Part 2 - Speculum Examination and Vaginal Examination

Gynecology examination Preliminary considerations Because of the sensitive nature of this physical examination, patients are often anxious, which can further complicate the exam itself. It is important to make sure the patient feels comfortable prior to proceeding. Always begin by explaining the procedure, the tools being used (e.g., speculum), why the gynecology examination is being done, and what you are looking for. Ask the patient how they feel and give them a chance to clarify any concerns they have with you. Let the patient know that they are still in control throughout the process. Assure them that you will not proceed if they are in pain or distress. Asking questions such as, “Is this painful in any way?” or “Are you alright with me proceeding?” will give the patient the feeling that they can stop the process if needed and help them relax. Explain what a chaperone is and whether the patient would like to have one present during their examination. Instruments and equipment Gynecologic exam: gloves, lubricant, vaginal speculum, cervicovaginal swab, paper towels Obstetric exam: measuring tape, Pinard stethoscope or doppler transducer, ultrasound gel, paper towels Cusco bivalved vaginal speculum Breast examination Preparation Before proceeding to breast examination, ask the patient what part of the menstrual cycle they are currently in. Ask the patient about any specific concerns (e.g., detected mass during breast self-examination). After explaining the details of the procedure and obtaining the patient's verbal consent, invite the patient to get undressed. The patient should be sitting upright during the examination. Breast inspection Evaluate the breasts' symmetricity and shape (e.g., swelling, breast masses). Check for any changes in skin color or texture (e.g., redness, peau d'orange, mamillary eczema, ulcerations). Evaluate the presence of nipple discharge. Inflammatory breast cancerErysipelas of the breastPaget disease of the breastLocal findings in breast cancerDiagnostic approach to nipple discharge Breast palpation The dominant hand should be used for palpation while the other hand provides support. A thorough tactile evaluation can be achieved with the following: Circular movements starting at the nipple and moving towards the periphery or vice-versa Vertical palpation of linear segments Palpation of each of the four breast quadrants Apply light pressure at first to scan for superficial changes and then proceed to deeper palpation of each of the breasts. Gently squeeze the sides of the nipple to detect the presence of any discharge. Join Our Telegram Channel Medical Videos , DIscussions for Medical Students and Junior Doctors https://t.me/medicalvideoslka Join TubeBuddy ( YouTube SEO Programme Today and Get 40% Discount) https://www.tubebuddy.com/yomal Watch New Video: /watch/8o0oSVWLhBaLo

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