Lekcja 3: Badanie i Ocena Stanu Pacjenta | Patient Examination and Assessment

Preparation for the Examination

Before beginning the gynecological examination, proper preparation is crucial to ensure both the patient’s comfort and the accuracy of the assessment.

  • Patient History:
    • The examination typically begins with a detailed patient history, focusing on menstrual history, sexual activity, contraception use, previous gynecological conditions, and any current symptoms.
    • The healthcare provider should also inquire about any concerns or questions the patient might have.
  • Informed Consent:
    • Before proceeding with the examination, it is essential to obtain informed consent from the patient. The provider should explain the purpose of the examination, what it will involve, and answer any questions the patient may have.
  • Environment and Positioning:
    • The examination room should be private, with a comfortable temperature. The patient is typically positioned in a dorsal lithotomy position, with her feet in stirrups. Draping should be used to maintain the patient’s dignity and comfort.

External Genital Examination

The examination begins with an assessment of the external genitalia, collectively known as the vulva. This initial step provides an opportunity to identify any visible abnormalities or signs of infection.

  • Inspection:
    • The healthcare provider visually inspects the mons pubis, labia majora, labia minora, clitoris, urethral meatus, and vaginal opening for any signs of redness, swelling, lesions, or discharge.
    • The provider should also note any signs of skin changes, such as lichenification or discoloration, which may indicate dermatological conditions.
  • Palpation:
    • Gentle palpation of the external genitalia can help identify any areas of tenderness, masses, or other abnormalities.
    • The Bartholin’s glands, located at the posterior aspect of the vaginal opening, should be palpated to check for swelling or abscess formation.

Speculum Examination

The speculum examination allows for the visual inspection of the vagina and cervix and is a key part of routine gynecological assessments.

  • Insertion of the Speculum:
    • The speculum, either metal or plastic, should be warmed before insertion to enhance patient comfort. It is inserted at a 45-degree angle and then rotated to a horizontal position once inside the vagina. The speculum is gently opened to allow visualization of the vaginal walls and cervix.
  • Visual Inspection:
    • The provider inspects the vaginal walls for signs of inflammation, discharge, or lesions. The cervix is examined for color, position, and any abnormalities such as polyps, erosions, or lesions.
    • The provider should also check for the presence of cervical mucus, which varies in consistency depending on the phase of the menstrual cycle.
  • Collection of Specimens:
    • During the speculum examination, specimens may be collected for laboratory testing. This typically includes a Pap smear (Papanicolaou test) to screen for cervical dysplasia and human papillomavirus (HPV) infection.
    • Additional samples may be taken for culture if there is a suspicion of infection.

Bimanual Examination

The bimanual examination is a palpation technique used to assess the internal reproductive organs, including the uterus, ovaries, and fallopian tubes.

  • Procedure:
    • The healthcare provider inserts two fingers into the vagina while applying pressure on the abdomen with the other hand. This allows the provider to assess the size, shape, position, and mobility of the uterus.
    • The ovaries and adnexa (the structures adjacent to the uterus, including the fallopian tubes) are also palpated to check for any masses, cysts, or tenderness.
  • Findings:
    • A normal uterus is typically pear-shaped, firm, and mobile. The ovaries may be palpable, especially in premenopausal women, and should be small, smooth, and non-tender.
    • Abnormal findings could include an enlarged uterus, masses, or tenderness, which may indicate conditions such as fibroids, ovarian cysts, or pelvic inflammatory disease (PID).

Rectovaginal Examination

In some cases, a rectovaginal examination may be performed, particularly when a more comprehensive assessment is needed.

  • Indications:
    • This examination is typically indicated for older women, those with a history of pelvic surgery, or when abnormalities are suspected during the bimanual examination.
  • Procedure:
    • The provider inserts one finger into the vagina and another into the rectum. This allows for a better assessment of the posterior pelvis, including the rectovaginal septum, uterosacral ligaments, and the posterior aspect of the uterus.
  • Findings:
    • This examination can help identify conditions such as rectovaginal fistulas, endometriosis, or malignancies that may not be detected through other examination techniques.