Within the clinic
Pelvic examination, also known as internal examination, is the most basic physical examination in obstetrics and gynecology. Senior professors of obstetrics and gynecology always urge young doctors not to forget their roots (internal examination). Young obstetricians and gynecologists often Use the consultation and judgment to write a prescription or jump directly to an ultrasound... and other advanced equipment examinations. There is an unwritten rule in the health insurance review: without internal diagnosis records, you cannot apply for an obstetrics and gynecology ultrasound. The following is an introduction to the pelvic examination. (This article Web page reference and excerpt from Novack's Gynecoloy 13rd Ed. Section I. Principles of Practice)
| pelvic exam | The most common typical position is Dorsal lithotomy position It’s best to empty your urine first | The patient's feet should be placed comfortably on the tripod. The edge of the buttocks can be fully inspected at the lower edge of the examination table. The speculum (duckbill) can be inserted into the vagina without any obstruction. |
| Inspection (Inspection) | Vulva, perineum (as well as the lower abdomen, pubic mound, anus, buttocks and coccyx) should be carefully examined for ulceration or suppuration, and bacterial culture should be considered | Pay attention to any lesions, redness, swelling, pigmentation, lumps or abnormal skin texture, trauma, scrapes, bruises... |
| palpation (Palpation) | Pathological sections should be considered for lesions | The size of any lesion should be measured, and the appearance and palpation sensation (movement, tenderness, hardness...) should be carefully described. |
| speculum (Speculum) (duck bill) | Insert it into the vagina and check the cervix carefully. Pay special attention to the vaginal vault in all areas of the vagina, which often hides lesions (such as cauliflower). Consider a Pap smear or consider an endometrial sample. Consider bacterial culture if ulceration or suppuration occurs. Consider pathological biopsy of any obvious lesions. | The duck's bill should be lubricated and at the right temperature. It's best to say this verbally before putting it in, otherwise someone will be startled. The size of the duck's bill should be appropriate and the cervix needs to be fully visible. The position of the cervix varies with the forward and backward tilt of the uterus. You can first gently expand and Move the duckbill opening, find it, and then twist it to the appropriate size. At the end of this stage, gently loosen the duckbill and take out the duckbill. |
| palpation (Palpation) | Gently enter the vagina with the index finger and middle finger, and carefully palpate the vagina, vaginal vault and cervix to see if there are any lumps or abnormalities. | You can lubricate it first and pay attention to the fact that the vagina is actually similar to an H shape, and the corners are easy to ignore. |
| Check with both hands (Bimanual) | Then enter the posterior fornix and touch the uterus with your fingers to see if there is any pain. Use the other hand to touch the lower abdomen above the pubic bone. The uterus can be completely touched. Then gently palpate the adnexa on both sides, paying attention to any pain and swelling. | During metritis, the pain will intensify. Pay attention to the size, shape, degree of freedom, appearance, hardness and position of the uterus (leaning forward, backward or in the middle). Carefully record size, shape, degrees of freedom, appearance, hardness and structure |
| Anal diagnosis (Rectal exam) | Pay attention to sphincter quality, pelvic laxity, hemorrhoids, anal and rectal lesions and it is recommended to conduct a fecal occult blood test at the same time | It is recommended that people over 40 years old undergo regular anal diagnosis |
| Vaginal and anal diagnosis (Rectovaginal) | Vaginal and anal examination can provide a clearer understanding of the scope of the lesion | Helps in staging cervical cancer or rectal and anal cancer |
After the pelvic examination (internal examination) is completed, the patient should be informed of any findings. If they are normal, reassure her. If there are any abnormal findings, inform the patient immediately in clear, concise and understandable terms and carefully discuss the next steps and recommended examinations or treatments. . Physicians must provide patients with the latest information on obstetrics and gynecology. Physicians must therefore strive to learn from formal medical education, internships, personal experiences, teachers, textbooks, in-service education, new knowledge lectures, written or online professional journals, and make good use of them. Obtain the latest knowledge to serve patients. Today’s medical insurance coverage cannot keep up with medical advancements. Physicians should not refrain from providing the latest medical information just because insurance does not cover it.