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Why do pelvic exams?
- routine health maintenance (pap)
- vulvar/vaginal complaints
- abdominal complaints
- STD exposure
What are the components of the examination?
- breast exam
- external pelvic
- internal pelvic
- bimanual exam (BME)
- rectal (if sx's or >50 yrs)
How can parity (# of deliveries) be further denoted?
- 1) term
- 2) preterm deliveries (20-36 wks)
- 3) abortions (before 20 wks)
- 4) living children
What are the abnormal vaginal bleeding patterns?
- polymenorrhea: <21 days between menses
- oligomenorrhea: infrequent bleeding
- menorrhagia: excessive flow
- metrorrhagia: intermenstrual bleeding
- postcoital bleeding
What instructions can you give to pts for the best pap results?
- do not douche/have intercourse within 24 hours
- empty the bladder
- **not always possible!**
What should you look at when examining the external structures during the pelvic exam?
- tanners if adolescent (maturity)
- mons, labia, perineum (lesions, swelling, redness)
- urethral meatus (irritation, inflammation, dilatation, discharge)
- introitus (tissue should be soft & moist, is hymen intact, look for prolapse, swelling, discoloration, discharge, lesions, fistulas, fissures)
- skene's ducts & bartholin's glands (swelling, discoloration, heat, tenderness; milk glands for discharge if they look abnl, culture any discharge)
What are you looking for when examining the cervix?
- color, position, surface characteristics, lesions, nodules, masses
- discharge or bleeding
What is the method to collect vaginal specimens?
- first: scrape with SPATULA (T-zone and SCJ)
- second: roll ENDOCERVICAL BRUSH in the os
- third: GC/CHLAMYDIA swab
- last: OTHER swabs for wet mount and/or KOH
- **can use cytobroom instead of spatula and cytobrush, if preggo use STERILE CTA moistened with saline instead of brush**
How do you use the spatula?
insert long arm into os, turn 360 to collect cells from external os
How do you use the cytobrush?
place brush into os, rotate 180 to collect endocervical cells
What is the size of the uterus if a woman is 12, 16, 20 or >20 wks pregnant?
- 12 wks: palpable @ symphysis pubis
- 16 wks: midway between pubis & umbilicus
- 20 wks: at umbilicus
- >20 wks: 1cm for ever week of gestation
When must you do a rectovaginal exam?
- if the uterus is not palpable (retroflexed)
- pt is >50 yrs
- pt has rectal complaints
What are the physical changes related to menopause?
- pubic hair: sparse & grey
- labia: smaller, flatter, dryer
- introitus: gaping/constricted
- vagina: narrower, atrophic, less rugated
- uterus: smaller
- ovaries: non-palpable
- rectal tone: weaker
What are the risk factors for developing cervical cancer?
- early sexual activity
- multiple partners
- H/O STDs
- no pap smear
- poor health & nutritional status
What strains of HPV cause 70% of cervical cancers? What strains cause 90% of genital warts?
What strains of HPV does the vaccine target?
- HPV 6, 11, 16, 18
- almost 100% effective in preventing HPV 16 & 18 related CIN adenocarcinoma in situ, reduces risk of anogenital warts, intraepithelial neoplasia, invasive cancers
What is the series of shots for HPV vaccination?
3 shots (0, 2 months, 6 months)
Who should get the HPV vaccine?
- girls/women 9-26
- the earlier the better, sexual activity is reported in girls <13 yrs (8%)
What is the most common STD reported in the US and is the most common in women?
chlamydia trachomatis (gonorrhea is similar)