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Routine pelvic exams are important for good reproductive health. A woman should have her first GYN exam when she first thinks about becoming sexually active, when she becomes sexually active or when she turns 18.
At the gynecologist, you will have a short general physical exam, including a breast exam. You will wear a hospital gown and nothing else. For the actual pelvic examination, you will lie down on an examination table with your feet resting in elevated “stirrups” (props that support your legs in the air). Stirrups might look a little scary, but they are there to keep you comfortable. Your legs will be spread apart, with your knees falling to each side so that your vagina is exposed. You may feel uncomfortable, but relax and realize that everyone goes through this.
External Exam
The practitioner will visually examine your vulva for discoloration, irritation, swelling and other abnormalities, and will gently feel for glands.
Internal Exam
There are two parts to the internal exam. The first involves a speculum, a metal or plastic instrument that the practitioner inserts into the vagina. The speculum is shaped like a duck’s bill, and once it is inserted into the vaginal canal, it is gently widened to spread the interior vaginal walls (this is not painful). As the vaginal walls are spread, the practitioner is able to see the walls of the vagina itself, and up the vaginal canal to the cervix. When viewing the vaginal canal and the cervix, the practitioner can look for discoloration, abnormal discharge, lesions, growths and signs of infection. It is possible for you to look at your own cervix during this process by propping yourself up on your elbows and using a mirror. Some practitioners ask if you would like to do this, but feel free to ask to if she doesn’t mention it first.
Pap Smear
Next the practitioner will take a pap smear. She/he uses a long-stemmed cotton swab to collect a sample of cells in the cervix. Some women feel a slight cramping sensation when their cervix is touched. The collected cells are smeared onto a slide and sent to a lab for testing and examination. The pap smear is extremely important for spotting abnormalities in the cervix which may indicate infection or disease.
STD Testing
If you are sexually active, the practitioner will test for STDs. The gynecologist will swab the inside of the cervix with a long cotton swab. The speculum is then taken out of the vagina. The samples are sent to a laboratory for various STD testing. The tests will probably take a couple days. Ask when your results will be available so you can call. If you want to be tested for HIV, syphilis, genital herpes or hepatitis you need to have blood taken. They can do that as well, but you will need to ask since it is not usually routine.
Manual Exam
The second part of the pelvic exam is called the manual or bi-manual exam. The practitioner will insert one or two fingers into your vagina and press with her/his other hand on the outside of your lower abdomen. They will use a lubricant on their fingers so it is more comfortable. The person can then feel the uterus, fallopian tubes and ovaries, and check for any swelling or tenderness. Once the doctor is finished checking your uterus and ovaries, the exam is complete. The entire pelvic exam (the parts involving your vagina, cervix, uterus, and ovaries) takes 3 to 5 minutes to complete.
Dr Chris Steele demonstrates a breast examination on a live model. This shows how to check yourself for early signs of tumours, cysts and other symptoms of breast cancer.
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ectal exam is an internal examination of the rectum such as by a physician or other healthcare professional.
The digital rectal examination (DRE, Latin palpatio per anum or PPA) is a relatively simple procedure. The patient is placed in a position where the anus is accessible and relaxed (lying on the side, squatting on the examination table, bent over the examination table, etc). The physician inserts a gloved and lubricated finger into the rectum through the anus and palpates the insides.
The DRE is inadequate as a screening tool for colorectal cancer because it examines less than 10% of the colorectal mucosa; colonoscopy is preferred. However, it's an important part of a general examination, as many tumors or other diseases are made manifest in the distal part of the rectum.
This examination may be used: * for the diagnosis of rectal tumors and other forms of cancer; * in males, for the diagnosis of prostatic disorders, notably tumors and benign prostatic hyperplasia; * for the diagnosis of appendicitis or other examples of an acute abdomen (i.e. acute abdominal symptoms indicating a serious underlying disease); * for the estimation of the tonicity of the anal sphincter, which may be useful in case of fecal incontinence or neurologic diseases, including traumatic spinal cord injuries; * in females, for gynecological palpations of internal organs * for examination of the hardness and color of the feces (ie. in cases of constipation, and fecal impaction); * prior to a colonoscopy or proctoscopy. * to evaluate haemorrhoids
The DRE is frequently combined with an FOBT (fecal occult blood test), which may be useful for diagnosing the etiology of an anemia and/or confirming a gastrointestinal bleed.
Sometimes proctoscopy may also be part of a rectal examination.
Bimanual pelvic exam of a female, using two fingers inside the vagina and one hand on the outside of the abdomen.
Colonoscopy is a test that allows your doctor to look at the inner lining of your large intestine (rectum and colon). He or she uses a thin, flexible tube called a colonoscope to look at the colon. A colonoscopy helps find ulcers, colon polyps, tumors, and areas of inflammation or bleeding.
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Electrical injuries can present with a variety of problems, including cardiac or respiratory arrest, coma, blunt trauma, and severe burns of several types. It is important to establish the type of exposure (high or low voltage), duration of contact, and concurrent trauma. Low-voltage AC injury without loss of consciousness and/or arrest These injuries are exposures of less than 1000V and usually occur in the home or office setting. Typically, children with electrical injuries present after biting or chewing on an electrical cord and suffer oral burns. Adults working on home appliances or electrical circuits can also experience these electrical injuries. Low-voltage AC may result in significant injury if there is prolonged, tetanic muscle contraction. Low-voltage AC injury with loss of consciousness and/or arrest In respiratory arrest or ventricular fibrillation that is not witnessed, an electrical exposure may be difficult to diagnose. All unwitnessed arrests should include this possibility in the differential diagnosis. Query EMS personnel, family, and coworkers about this possibility. Inquire if a scream was heard before the patient’s collapse; this may be due to involuntary contraction of chest wall muscles from electrical current. High-voltage AC injury without loss of consciousness and/or arrest Usually high-voltage injuries do not cause loss of consciousness but instead cause devastating thermal burns. In occupational exposures, details of voltage can be obtained from the local power company. High-voltage AC injury with loss of consciousness and/or arrest This is an unusual presentation of high-voltage AC injuries, which do not often cause loss of consciousness. History may need to come from bystanders or EMS personnel. Direct current (DC) injury These injuries typically cause a single muscle contraction that throws the victim away from the source. They are rarely associated with loss of consciousness unless there is severe head trauma, and victims can often provide their own history. Conducted electrical devices Conducted electrical weapons (CEWs) such as tasers are weapons used by law enforcement that deliver high-voltage current that is neither true AC or DC but is most like a series of low-amplitude DC shocks.[16] They can deliver 50,000 V in a 5-second pulse, with an average current of 2.1 mA.[17] Though they have been temporally associated with deaths in the law enforcement setting, conducted electrical devices (CEDs) in healthy volunteers have been shown to be safe without evidence of delayed arrhythmia or cardiac damage as measured by troponin I.[18, 17] One study of their use in 1201 law enforcement incidents showed mostly superficial puncture wounds from the device probes, and significant injuries only from trauma subsequent to shock, not from the device itself. Of 2 deaths in custody, neither was related to CEW exposure.[19]
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Intussusception (in-tuh-suh-SEP-shun) is a serious condition in which part of the intestine slides into an adjacent part of the intestine. This "telescoping" often blocks food or fluid from passing through. Intussusception also cuts off the blood supply to the part of the intestine that's affected, which can lead to a tear in the bowel (perforation), infection and death of bowel tissue.
A testicular examination is mainly performed on male patients who present with testicular pathology e.g. pain, swelling, a lump. Although titled testicular examination it involves the examination of the penis, scrotum and testes. As this is an intimate examination it is pertinent to gain a good rapport with your patient, maintain good communication and ensure the patient’s dignity at all times. Remember to offer a chaperone for this skill. For the purposes of your exam, you will most likely be examining a mannequin.