Vagina Examination

Vagina Examination
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Hello, Thanks for taking a look here, I'm James Gill, a medical doctor, and GP having a crack at transitioning my students from textbooks to something else

This is sort of an evolving channel coming off the back of my previous clinical examination videos filmed at Warwick Medical School. I spend most Fridays teaching clinical skills and feel it is the foundation of a good doctor.

The main focus here is going to giving good quality information for junior doctors and medical students to improve their clinical skills and thus improve their OSCE grade, and overall clinical knowledge

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Thanks and hope you find a benefit here :)
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LeBlond RF, et al., eds. The female genitalia and reproductive system. In: DeGowin's Diagnostic Examination. 10th ed. New York, N.Y.: McGraw-Hill Education; 2015. http://www.accessmedicine.com. Accessed Feb. 3, 2017.
Frequently asked questions: Especially for teens FAQ150. Your first gynecological visit. American College of Obstetricians and Gynecologists. http://www.acog.org/Patients/FAQs/Your-First-Gynecologic-Visit-Especially-for-Teens. Accessed Feb. 3, 2017.
Frequently asked questions: Abnormal cervical cancer screening test results. FAQ187. American College of Obstetricians and Gynecologists. http://www.acog.org/Patients/FAQs/Abnormal-Cervical-Cancer-Screening-Test-Results. Accessed Feb. 3, 2017.
Carusi DA, et al. The gynecologic history and pelvic examination. http://www.uptodate.com/home. Accessed Feb. 3, 2017.
Butler Tobah YS (expert opinion). Mayo Clinic, Rochester, Minn. Feb. 23, 2017.

Adenomyosis

Anterior vaginal prolapse (cystocele)

Bacterial vaginosis

Bartholin's cyst

Cervicitis

Chronic pelvic pain in women

Endometrial cancer

Endometriosis

Female reproductive system

Incompetent cervix

Infertility

Interstitial cystitis

Low sex drive in women

Miscarriage

Ovarian cancer

Ovarian cysts

Painful intercourse (dyspareunia)

Pap test

Pelvic exam

Pelvic inflammatory disease (PID)

Polycystic ovary syndrome (PCOS)

Posterior vaginal prolapse (rectocele)

Preterm labor

Primary ovarian insufficiency

Small bowel prolapse (enterocele)

Uterine fibroids

Uterine prolapse

Vaginal atrophy

Vaginal cancer

Vaginitis

Vulvodynia

Yeast infection (vaginal)

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The ovaries, fallopian tubes, uterus, cervix and vagina (vaginal canal) make up the female reproductive system.
During a pelvic exam, a doctor evaluates your reproductive organs. You might have a pelvic exam as part of your regular checkup. Or your doctor might recommend a pelvic exam if you have symptoms such as unusual vaginal discharge or pelvic pain.
A pelvic exam usually lasts only a few minutes. Your doctor checks your vulva, vagina, cervix, ovaries, uterus, rectum and pelvis for any abnormalities. A Pap test, which screens for cervical cancer, is often performed during a pelvic exam.
To assess your gynecological health. A pelvic exam often is part of a routine physical exam to find possible signs of ovarian cysts, sexually transmitted infections, uterine fibroids or early-stage cancer. Pelvic exams are also commonly performed during pregnancy.
There is a lot of debate among experts regarding the recommended frequency of pelvic exams. Ask your doctor what he or she recommends.
You don't need to do anything special to prepare for a pelvic exam. For your own comfort, you might want to schedule your pelvic exam on a day when you don't have your period. Also, you might be more comfortable if you empty your bladder before the exam.
If you have questions about the exam or its possible results, consider writing down your questions and taking them with you to the appointment so that you don't forget to ask them.
A pelvic exam is done in your doctor's office and takes only a few minutes.
You'll be asked to change out of your clothes and into a gown. You might be given a sheet to wrap around your waist for added privacy. Before performing the pelvic exam, your doctor might listen to your heart and lungs and perform an abdominal, back and breast exam.
In a pelvic exam, your health care provider inserts two gloved fingers inside your vagina. Pressing down on your abdomen at the same time, your provider can examine your uterus, ovaries and other organs.
In a Pap test, your doctor uses a vaginal speculum to hold your vaginal walls apart and to see the cervix. Next, a sample of cells from your cervix is collected using a small cone-shaped brush and a tiny plastic spatula (1 and 2). Your doctor then rinses the brush and spatula in a liquid-filled vial (3) and sends the vial to a laboratory for testing.
You'll lie on your back on an exam table with your knees bent and your feet placed on the corners of the table or in supports (stirrups). You'll be asked to slide your body toward the end of the table and let your knees fall open.
Internal visual exam. Next, your doctor uses a speculum — a plastic or metal-hinged instrument shaped like a duck's bill — to spread open your vaginal walls and see your vagina and cervix. The speculum might be warmed before it's inserted to make it more comfortable for you.
Inserting and opening the speculum causes pressure that can be uncomfortable for some women. Relax as much as possible to ease discomfort, but tell your doctor if you're in pain.
Physical exam. Because your pelvic organs, including your uterus and ovaries, can't be seen from outside your body, your doctor needs to feel (palpate) your abdomen and pelvis for this part of the exam. Your doctor will insert two lubricated, gloved fingers into your vagina with one hand, while the other hand presses gently on the outside of your lower abdomen.
During this part of the exam, your doctor will check the size and shape of your uterus and ovaries, noting any tender areas or unusual growths. After the vaginal exam, your doctor will insert a gloved finger into your rectum to check for tenderness, growths or other irregularities.
Your doctor should tell you exactly what he or she is doing at each step so that nothing comes as a surprise to you.
After the pelvic exam is over, you can get dressed. Then, your doctor will discuss the results of your exam.
Your doctor can usually tell you immediately if the exam revealed anything unusual. Pap test results might take a few days. Your doctor will discuss with you any next steps, additional tests, follow-up or treatment that you need.
Your pelvic exam is a good time to talk to your doctor about your sexual or reproductive health. If you have questions, be sure to discuss them during your visit.
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Lichen Sclerosis – itching without any discharge, all age groups

Vaginal Discharge --> This case shows yeast vulvovaginitis – common cause of vaginal itching and/or discharge, common in hospitalized patients, especially if getting antibiotics.
Also note, bacterial vaginosis is another common cause of discharge and often we need a microscope to differentiate between the two.

Trichomonas infection causing a “Strawberry cervix”

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Pelvic exam is a important part of the exam for female patients and important towards making various diagnoses such as yeast vulvovaginitis, bacterial vaginosis, lichen sclerosis, cancers such as cervical cancer, anal/rectal cancer, fibroids, sexually-transmitted infections (gonorrhea, chlamydia, trichomonas, syphilis, herpes and human papillomavirus/genital warts) and many other diagnoses.
The pelvic exam is a vital part of every woman's preventative care and is also important towards making a number of diagnoses when presenting with abdominal or pelvic complaints. Here we cover each aspect of the pelvic exam and demonstrate both in text and in our video how this done.
The main equipment you will use is the speculum so it's important for you to understand the most commonly used types. These include the:
Example of a Grave's (or Duckbill) speculum which is a little wider, often used for prodecures. Image credit
Pederson (most common) vs the Grave's (or Duckbill) speculum. Image credit
o  Look for inguinal region for lymphadenopathy-- click here for lymph node exam
1. Examine the vulvar region looking for erythema or other rashes
2. Place lubricant on both index finder of non-dominant hand and warmed speculum
3.  Insert index finger into base of vagina
4. Touch speculum onto patient’s thigh to see if temperature appropriate then insert speculum at slight angle into vagina above finger and rotate to level position as it's inserted
Important: Insert speculum all the way BEFORE opening
5. Open speculum and adjust until the cervix is in sight and lock open
6. If planned, conduct pap smear and STD testing
Note: a little bleeding (especially if patient nulliparous) after a pap smear is expected. If bleeding profuse of cervix is erythematous and/or purulent discharge present, suspect cervicitis (gonorrhea, chlamydia).
Insert index finger and possibly additional finger (with lubricant) in vaginal canal with non-dominant had free to palpate the abdomen.
o  Hospitalized patients – Given a proper exam table with leg rests is often not available, if possible delay this exam until patient can be seen in clinic. However if speculum exam is needed immediately, one method is to place an inverted bedpan under the patient’s buttocks to raise pelvis. If yeast vulvovaginitis is suspected, you or patient can obtain a swab and look under microscope or send to lab.
o  Patient’s first exam or elderly patients – May require more discussion and education prior to the exam
o  Patients with history of trauma – ensure patient knows they have control and can stop the exam at anytime
The key topics of the pelvic exam include:

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Vagina Examination

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