Badanie fizykalne układu płciowego żeńskiego | Female Reproductive System Examination

Tooltip .tooltip { position: relative; cursor: pointer; text-decoration: none; border-bottom: 1px dashed rgba(0, 0, 0, 0.6); } .tooltip::before { content: attr(data-tooltip); position: absolute; top: -40px; /* Trochę niżej nad słowem */ left: 50%; /* Wyśrodkowanie */ transform: translateX(-50%); background-color: rgba(255, 255, 255, 0.9); color: #333; padding: 6px 12px; border-radius: 8px; white-space: nowrap; opacity: 0; visibility: hidden; transition: opacity 0.3s ease, visibility 0.3s ease; font-family: ‘Arial’, sans-serif; font-size: 14px; box-shadow: 0px 4px 8px rgba(0, 0, 0, 0.1); z-index: 10; } .tooltip:hover::before { opacity: 1; visibility: visible; } document.addEventListener(‘DOMContentLoaded’, function () { const wordsToTooltip = { “general inspection”: “Ogólne oględziny”, “external genitalia”: “Zewnętrzne narządy płciowe”, “surrounding areas”: “Okolice otaczające”, “signs of pathology”: “Objawy patologii”, “skin changes”: “Zmiany skórne”, “swelling”: “Obrzęk”, “asymmetry”: “Asymetria”, “discoloration”: “Przebarwienia”, “scarring”: “Blizny”, “trauma”: “Uraz”, “hormonal imbalance”: “Zaburzenie hormonalne”, “hirsutism”: “Hirsutyzm”, “distribution of pubic hair”: “Rozmieszczenie owłosienia łonowego”, “hormonal imbalances”: “Zaburzenia hormonalne”, “endocrine disorders”: “Zaburzenia endokrynologiczne”, “lower abdomen”: “Podbrzusze”, “masses”: “Guzki”, “distension”: “Rozdęcie”, “scars”: “Blizny”, “visible pulsations”: “Widoczne pulsacje”, “hernias”: “Przepukliny”, “inguinal lymph nodes”: “Węzły chłonne pachwinowe”, “lymphadenopathy”: “Limfadenopatia”, “infection”: “Infekcja”, “malignancy”: “Nowotwór złośliwy”, “external genital examination”: “Badanie zewnętrznych narządów płciowych”, “vulva”: “Srom”, “perineum”: “Krocze”, “labia majora”: “Wargi sromowe większe”, “labia minora”: “Wargi sromowe mniejsze”, “erythema”: “Rumień”, “lesions”: “Zmiany skórne”, “pigmentation changes”: “Zmiany pigmentacji”, “ulcerations”: “Owrzodzenia”, “clitoris”: “Łechtaczka”, “clitoromegaly”: “Przerost łechtaczki”, “hormonal disorder”: “Zaburzenie hormonalne”, “urethral meatus”: “Ujście cewki moczowej”, “discharge”: “Wydzielina”, “urethral caruncles”: “Mięsaki cewki moczowej”, “urethral prolapse”: “Wypadanie cewki moczowej”, “periurethral area”: “Okolica okołocewkowa”, “tenderness”: “Tkliwość”, “Bartholin’s glands”: “Gruczoły Bartholina”, “Skene’s glands”: “Gruczoły Skene’a”, “abscess formation”: “Tworzenie się ropni”, “Bartholin’s gland cysts”: “Torbiele gruczołu Bartholina”, “urethritis”: “Zapalenie cewki moczowej”, “perineal region”: “Okolica krocza”, “lacerations”: “Rany szarpane”, “fistulas”: “Przetoki”, “fissures”: “Szczeliny”, “hemorrhoids”: “Hemoroidy”, “prolapse”: “Wypadanie”, “perineal scars”: “Blizny w okolicy krocza”, “pelvic floor health”: “Zdrowie dna miednicy”, “vaginal examination”: “Badanie pochwy”, “speculum examination”: “Badanie wziernikiem”, “vaginal canal”: “Kanał pochwy”, “cervix”: “Szyjka macicy”, “pH testing”: “Badanie pH”, “bacterial vaginosis”: “Bakteryjna waginoza”, “speculum insertion”: “Wprowadzenie wziernika”, “patient comfort”: “Komfort pacjentki”, “vaginal walls”: “Ściany pochwy”, “color”: “Barwa”, “moisture”: “Wilgotność”, “atrophy”: “Zanik”, “cysts”: “Torbiele”, “polyps”: “Polipy”, “rugae”: “Fałdy pochwy”, “low estrogen”: “Niski poziom estrogenu”, “postmenopausal women”: “Kobiety po menopauzie”, “transformation zone”: “Strefa transformacji”, “Nabothian cysts”: “Torbiele Nabotha”, “cervical erosion”: “Nadżerka szyjki macicy”, “cervical ectropion”: “Ektropion szyjki macicy”, “cervical erythema”: “Rumień szyjki macicy”, “Pap smear”: “Cytologia”, “HPV testing”: “Test na HPV”, “bimanual examination”: “Badanie dwuręczne”, “internal reproductive organs”: “Wewnętrzne narządy rozrodcze”, “uterus”: “Macica”, “adnexa”: “Przydatki”, “fallopian tubes”: “Jajowody”, “pelvic floor”: “Dno miednicy”, “insertion of fingers”: “Wprowadzenie palców”, “cervical motion tenderness”: “Tkliwość przy poruszaniu szyjką macicy”, “pelvic inflammatory disease (PID)”: “Zapalenie narządów miednicy mniejszej”, “uterine enlargement”: “Powiększenie macicy”, “fibroids”: “Mięśniaki macicy”, “ovarian cysts”: “Torbiele jajników”, “ectopic pregnancy”: “Ciąża pozamaciczna”, “hydrosalpinx”: “Wodonercze jajowodu”, “pelvic organ prolapse”: “Wypadanie narządów miednicy”, “pelvic floor muscles”: “Mięśnie dna miednicy”, “pelvic floor muscle strength”: “Siła mięśni dna miednicy”, “rectovaginal examination”: “Badanie rektowaginalne”, “posterior pelvic structures”: “Tylne struktury miednicy”, “rectal tone”: “Napięcie odbytnicy”, “occult blood”: “Krew utajona”, “rectovaginal septum”: “Przegroda rektowaginalna”, “uterosacral ligaments”: “Więzadła maciczno-krzyżowe”, “posterior uterine wall”: “Tylna ściana macicy”, “retroverted uterus”: “Tyłozgięcie macicy”, “endometriosis”: “Endometrioza”, “tumors”: “Guzy”, “gynecological care”: “Opieka ginekologiczna”, “patient education”: “Edukacja pacjentki”, “breast examination”: “Badanie piersi”, “inspection”: “Oględziny”, “palpation”: “Badanie palpacyjne”, “symmetry”: “Symetria”, “skin changes”: “Zmiany skórne”, “dimpling”: “Dołkowanie”, “puckering”: “Marszczenie”, “nipple abnormalities”: “Nieprawidłowości brodawek”, “nipple inversion”: “Wciągnięcie brodawki”, “axillary region”: “Okolica pachowa”, “lymph node enlargement”: “Powiększenie węzłów chłonnych”, “concentric circles”: “Okrężne ruchy”, “vertical strips”: “Pionowe paski”, “axillary lymph nodes”: “Węzły chłonne pachowe”, “supraclavicular lymph nodes”: “Węzły chłonne nadobojczykowe”, “infraclavicular lymph nodes”: “Węzły chłonne podobojczykowe”, “nipple discharge”: “Wydzielina z brodawki”, “breast lumps”: “Guzki w piersi”, “breast health education”: “Edukacja na temat zdrowia piersi”, “self-examination techniques”: “Techniki samobadania piersi” }; // Normalize keys in the dictionary const normalizedWordsToTooltip = {}; for (const [key, value] of Object.entries(wordsToTooltip)) { const cleanedKey = 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border-bottom: 0.5px dashed rgba(0, 0, 0, 0.2); } .tooltip::before { content: attr(data-tooltip); position: absolute; background-color: rgba(255, 255, 255, 0.9); color: #333; padding: 6px 12px; border-radius: 8px; opacity: 0; visibility: hidden; transform: translateY(-100%); transition: opacity 0.3s ease, visibility 0.3s ease, transform 0.3s ease; font-family: ‘Arial’, sans-serif; font-size: 14px; box-shadow: 0px 4px 8px rgba(0, 0, 0, 0.1); z-index: 10; /* Adjust for dynamic width */ max-width: 250px; /* Prevent tooltips from being too wide */ overflow-wrap: break-word; /* Break long words */ word-wrap: break-word; /* For older browsers */ text-align: left; } .tooltip:hover::before { opacity: 1; visibility: visible; transform: translateY(-130%); left: 50%; transform: translateX(-50%) translateY(-130%); } document.addEventListener(‘DOMContentLoaded’, function () { const wordsToTooltip = { “general inspection”: “ogólna ocena”, “external genitalia”: “zewnętrzne narządy płciowe”, “surrounding areas”: “obszary otaczające”, “signs of pathology”: “oznaki patologii”, “skin changes”: “zmiany skórne”, “swelling”: “obrzęk”, “asymmetry”: “asymetria”, “discoloration”: “przebarwienia”, “scarring”: “blizny”, “trauma”: “uraz”, “hormonal imbalance”: “zaburzenie hormonalne”, “hirsutism”: “hirsutyzm”, “distribution of pubic hair”: “rozmieszczenie owłosienia łonowego”, “hormonal imbalances”: “zaburzenia hormonalne”, “endocrine disorders”: “zaburzenia endokrynologiczne”, “lower abdomen”: “podbrzusze”, “masses”: “guzy”, “distension”: “rozdęcie”, “scars”: “blizny”, “visible pulsations”: “widoczne pulsacje”, “hernias”: “przepukliny”, “inguinal lymph nodes”: “węzły chłonne pachwinowe”, “lymphadenopathy”: “limfadenopatia”, “infection”: “infekcja”, “malignancy”: “nowotwór złośliwy”, “external genital examination”: “badanie zewnętrznych narządów płciowych”, “vulva”: “srom”, “perineum”: “krocze”, “labia majora”: “wargi sromowe większe”, “labia minora”: “wargi sromowe mniejsze”, “erythema”: “rumień”, “lesions”: “zmiany”, “pigmentation changes”: “zmiany pigmentacji”, “ulcerations”: “owrzodzenia”, “clitoris”: “łechtaczka”, “clitoromegaly”: “przerost łechtaczki (clitoromegalia)”, “hormonal disorder”: “zaburzenie hormonalne”, “urethral meatus”: “ujście cewki moczowej”, “discharge”: “wydzielina”, “urethral caruncles”: “mięsaki cewki moczowej”, “urethral prolapse”: “wypadanie cewki moczowej”, “periurethral area”: “obszar okołocewkowy”, “tenderness”: “tkliwość”, “Bartholin’s glands”: “gruczoły Bartholina”, “Skene’s glands”: “gruczoły Skene’a”, “swelling”: “obrzęk”, “abscess formation”: “tworzenie się ropni”, “Bartholin’s gland cysts”: “torbiele gruczołu Bartholina”, “urethritis”: “zapalenie cewki moczowej”, “perineal region”: “obszar krocza”, “lacerations”: “otarcia”, “fistulas”: “przetoki”, “fissures”: “szczeliny”, “hemorrhoids”: “hemoroidy”, “prolapse”: “wypadanie”, “perineal scars”: “blizny na kroczu”, “pelvic floor health”: “zdrowie dna miednicy”, “vaginal examination”: “badanie pochwy”, “speculum examination”: “badanie wziernikiem”, “vaginal canal”: “kanał pochwy”, “cervix”: “szyjka macicy”, “pH testing”: “badanie pH”, “bacterial vaginosis”: “bakteryjna waginoza”, “speculum insertion”: “wprowadzenie wziernika”, “patient comfort”: “komfort pacjentki”, “vaginal walls”: “ściany pochwy”, “color”: “kolor”, “moisture”: “wilgotność”, “atrophy”: “zanik”, “cysts”: “torbiele”, “polyps”: “polipy”, “rugae”: “fałdy”, “low estrogen”: “niski poziom estrogenu”, “postmenopausal women”: “kobiety po menopauzie”, “transformation zone”: “strefa transformacji”, “Nabothian cysts”: “torbiele Nabotha”, “cervical erosion”: “nadżerka szyjki macicy”, “cervical ectropion”: “ektropion szyjki macicy”, “cervical erythema”: “rumień szyjki macicy”, “Pap smear”: “cytologia”, “HPV testing”: “test na HPV”, “bimanual examination”: “badanie dwuręczne”, “internal reproductive organs”: “wewnętrzne narządy rozrodcze”, “uterus”: “macica”, “adnexa”: “przydatki”, “fallopian tubes”: “jajowody”, “pelvic floor”: “dno miednicy”, “insertion of fingers”: “wprowadzenie palców”, “cervical motion tenderness”: “tkliwość przy ruchu szyjki macicy”, “pelvic inflammatory disease (PID)”: “zapalenie narządów miednicy mniejszej (PID)”, “uterine enlargement”: “powiększenie macicy”, “fibroids”: “mięśniaki”, “ovarian cysts”: “torbiele jajników”, “ectopic pregnancy”: “ciąża pozamaciczna”, “hydrosalpinx”: “wodonercze jajowodu”, “pelvic organ prolapse”: “wypadanie narządów miednicy”, “pelvic floor muscles”: “mięśnie dna miednicy”, “pelvic floor muscle strength”: “siła mięśni dna miednicy”, “rectovaginal examination”: “badanie rektowaginalne”, “posterior pelvic structures”: “tylne struktury miednicy”, “rectal tone”: “napięcie odbytnicy”, “occult blood”: “krew utajona”, “rectovaginal septum”: “przegroda rektowaginalna”, “uterosacral ligaments”: “więzadła maciczno-krzyżowe”, “posterior uterine wall”: “tylna ściana macicy”, “retroverted uterus”: “tyłozgięcie macicy”, “endometriosis”: “endometrioza”, “tumors”: “guzy”, “gynecological care”: “opieka ginekologiczna”, “patient education”: “edukacja pacjentki”, “breast examination”: “badanie piersi”, “inspection”: “oględziny”, “palpation”: “badanie palpacyjne”, “symmetry”: “symetria”, “skin changes”: “zmiany skórne”, “dimpling”: “dołkowanie”, “puckering”: “marszczenie”, “nipple abnormalities”: “nieprawidłowości brodawek”, “nipple inversion”: “wciągnięcie brodawki”, “axillary region”: “okolica pachowa”, “lymph node enlargement”: “powiększenie węzłów chłonnych”, “concentric circles”: “okrężne ruchy”, “vertical strips”: “pionowe paski”, “axillary lymph nodes”: “węzły chłonne pachowe”, “supraclavicular lymph nodes”: “węzły chłonne nadobojczykowe”, “infraclavicular lymph nodes”: “węzły chłonne podobojczykowe”, “nipple discharge”: “wydzielina z brodawki”, “breast lumps”: “guzki w piersi”, “breast health education”: “edukacja na temat zdrowia piersi”, “self-examination techniques”: “techniki samobadania piersi” 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Szacowany czas lekcji: 14 minut
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Observation

The first step in the physical examination is the general inspection of the external genitalia and surrounding areas. During this stage, the clinician looks for any signs of pathology, such as skin changes, swelling, asymmetry, or discoloration. Scarring, trauma, and signs of hormonal imbalance, such as hirsutism, are also noted.

The clinician should also assess the distribution of pubic hair, as abnormal distribution may indicate hormonal imbalances or endocrine disorders. The lower abdomen is inspected for masses, distension, or scars that could impact the reproductive organs, and any visible pulsations or hernias in the lower abdomen are also noted. Additionally, the inguinal lymph nodes are palpated to check for lymphadenopathy, which could indicate infection or malignancy.

External Genital Examination

The external genital examination begins with inspection of the vulva, perineum, and surrounding structures. Key areas of focus include:

  • Labia Majora and Labia Minora: Inspect for any swelling, erythema, lesions, or asymmetry. Palpate the labia for masses or tenderness. The labia majora should be smooth without nodularity, while the labia minora should be assessed for any changes in pigmentation or ulcerations.
  • Clitoris: Inspect the clitoral area for any abnormalities, such as enlargement, discoloration, or lesions. Clitoromegaly may indicate an underlying hormonal disorder and should be evaluated further if detected.
  • Urethral Meatus: Examine the urethral opening for discharge, signs of irritation, or prolapse. Palpate the periurethral area to assess for any tenderness. Urethral caruncles or prolapse are noted, and any discharge may be indicative of infection.
  • Bartholin’s and Skene’s Glands: Palpate the Bartholin’s glands bilaterally for swelling or tenderness, and express any fluid if possible to evaluate for infection. Swelling or abscess formation can indicate Bartholin’s gland cysts or infections. Skene’s glands should also be examined for signs of inflammation or discharge, which can be a sign of underlying urethritis.
  • Perineum and Anus: Inspect the perineal region for lacerations, scars, fistulas, or other abnormalities. The anus is evaluated for fissures, hemorrhoids, or any evidence of prolapse. Perineal scars may indicate past trauma or episiotomy, and the condition of the perineum is important in assessing pelvic floor health.

Vaginal Examination

After completing the inspection of the external genitalia, a speculum examination is performed to assess the vaginal canal and cervix. In some cases, pH testing of vaginal secretions may be conducted if there are signs of infection, as different pH levels can indicate bacterial vaginosis or other infections.

  • Speculum Insertion: A warmed and lubricated speculum is gently inserted at an angle into the vaginal canal. The speculum is gradually opened to visualize the vaginal walls and cervix. Patient comfort is prioritized, and insertion is done slowly, with reassurance provided throughout. The size and type of speculum should be chosen based on the patient’s anatomy and history, and the examiner should be attentive to any signs of discomfort.
  • Vaginal Walls: Inspect the vaginal walls for color, moisture, lesions, or signs of atrophy. Observe for any cysts, polyps, or masses. The presence of rugae indicates healthy estrogen levels, while smooth or atrophic vaginal walls may suggest low estrogen, often seen in postmenopausal women.
  • Cervix: The cervix is evaluated for its position, shape, and surface characteristics. Note the presence of any discharge, friability, or lesions. The transformation zone should be assessed for any abnormalities, such as Nabothian cysts, erosion, or suspicious masses. Cervical ectropion or erythema may also be observed and should be documented.

A cervical sample may be taken for a Pap smear or HPV testing, depending on screening guidelines or patient history. This step is crucial for the early detection of precancerous or cancerous changes in the cervical epithelium.

Bimanual Examination

The bimanual examination assesses the internal reproductive organs, including the uterus, adnexa (ovaries and fallopian tubes), and pelvic floor. During this examination, the clinician differentiates between pain in the uterus, adnexa, or other pelvic regions, which can aid in making a differential diagnosis.

  • Insertion of Fingers: The examiner inserts two lubricated, gloved fingers into the vagina while the other hand is placed on the lower abdomen. The purpose is to palpate and assess the internal structures. The examination is done with care to avoid causing discomfort.
  • Cervix: The cervix is palpated for consistency, mobility, and tenderness. A healthy cervix should be firm but not rigid and should move without causing significant discomfort. Cervical motion tenderness may indicate pelvic inflammatory disease (PID). Any fixation of the cervix may suggest underlying adhesions or endometriosis.
  • Uterus: The size, shape, position (anteverted, retroverted, midline), and mobility of the uterus are assessed. The examiner notes any masses, tenderness, or irregularities. Uterine enlargement may suggest pregnancy, fibroids, or other pathologies. The presence of fibroids is typically noted, including their size and location, as they can impact reproductive health.
  • Adnexa: The adnexa (ovaries and fallopian tubes) are palpated bilaterally. The ovaries are typically almond-shaped and mobile; tenderness or enlargement warrants further evaluation. Masses in the adnexa may indicate ovarian cysts, tumors, or ectopic pregnancy. The fallopian tubes are generally not palpable unless pathology is present, such as hydrosalpinx or ectopic pregnancy.
  • Pelvic Floor Muscles: The tone and strength of the pelvic floor muscles are assessed by having the patient perform a voluntary contraction. Weakness may indicate pelvic organ prolapse or other dysfunctions. Pelvic floor muscle strength is graded, and any signs of pelvic floor disorders, such as incontinence or prolapse, are noted.

Rectovaginal Examination

In some circumstances, particularly when evaluating the posterior pelvic structures or if there is suspicion of pathology, a rectovaginal examination is performed. During this examination, the clinician also assesses rectal tone and evaluates for occult blood if necessary, which may provide additional information regarding colorectal health.

  • Technique: The examiner inserts one finger into the rectum and one into the vagina, allowing simultaneous palpation of the rectovaginal septum. This technique allows for better assessment of the uterosacral ligaments, posterior uterine wall, and any retroverted uterine masses. It is particularly useful in assessing structures that may not be easily accessible through a vaginal examination alone.
  • Findings: The rectovaginal septum should be smooth without nodularity. Masses, tenderness, or thickening may indicate endometriosis, tumors, or other abnormalities. Palpation of the uterosacral ligaments may reveal tenderness or nodularity, which are often associated with endometriosis.

The physical examination of the female reproductive system is an essential component of comprehensive gynecological care. It enables the clinician to identify abnormalities, guide diagnostic decisions, and provide timely management of potential health issues while ensuring patient comfort and respect. Patient education is also important; explaining the findings and next steps can help alleviate anxiety and promote better health outcomes.

Breast Examination

Although not part of the internal reproductive system, breast examination is an integral part of the female health assessment. The breast examination involves both inspection and palpation to assess for abnormalities.

  • Inspection: The patient is initially seated with her arms at her sides, and then in different positions, such as raising the arms, pressing them against the hips, or leaning forward. The clinician inspects both breasts for symmetry, skin changes (such as dimpling, puckering, or erythema), and nipple abnormalities, including inversion or discharge. Inspection should also include the axillary region to identify any skin changes or visible lymph node enlargement.
  • Palpation: The palpation is performed with the patient lying down, with one arm behind the head to flatten the breast tissue. Using the pads of the fingers, the examiner palpates the entire breast in a systematic pattern, such as concentric circles or vertical strips, to identify any masses, areas of tenderness, or thickening. The axillary, supraclavicular, and infraclavicular lymph nodes are also palpated to detect any enlargement. Palpation should be thorough, covering the entire breast from the clavicle to the inframammary fold and from the sternum to the mid-axillary line.
  • Nipple Examination: The nipples are gently compressed to assess for discharge. Any spontaneous nipple discharge should be documented, noting the color and consistency. Discharge that is bloody or occurs without manipulation may be a sign of a more serious condition and requires further evaluation.

The breast examination is crucial for early detection of abnormalities, such as lumps or suspicious changes that may warrant further investigation, including imaging or biopsy. Breast health education, including self-examination techniques, should be provided to encourage patients to monitor their own breast health regularly.