扬州大学：《妇产科学》课程教学课件（PPT讲稿）43 妇科技能培训

Gynecology skills trainingTheDept.of clinicalmedicine,yangzhoumedical college

Gynecology skills training The Dept. of clinical medicine ,yangzhou medical college

contents1.gynecologic examination （"bimanualexam)2.culdocentesis3.cervicalsmea

contents ⚫ 1. gynecologic examination（"bimanual exam） ⚫ 2. culdocentesis ⚫ 3. cervical smea

PelvicexaminationTheexamination canbeuncomfortableDuring the pelvic exam the vaginal wall isassessed forrugae,texture andweak spotsInadditiontoathoroughpelvic exam,othertests may ordered to further determine thecauseofsymptomsthatareconcerning.Duringthepelvicexam,samplesofvaginalfluidsmaybetakentoscreenforsexuallytransmitted infections or otherinfections

Pelvic examination ⚫ The examination can be uncomfortable. During the pelvic exam the vaginal wall is assessed for rugae, texture and weak spots. In addition to a thorough pelvic exam, other tests may ordered to further determine the cause of symptoms that are concerning.During the pelvic exam, samples of vaginal fluids may be taken to screen for sexually transmitted infections or other infections

PelvicexaminationSome clinicians combinea routine pelvicexam alongwithotherpreventativeprocedures like a breast examination andpap smear

Pelvic examination ⚫ Some clinicians combine a routine pelvic exam along with other preventative procedures like a breast examination and pap smear

ExternalexaminationThepelvic exambegins withan explanation of theprocedure.Thewoman isaskedto put onanexamination gown,get on the examination table, layonherbackwithherfeetinstirrups.Slidingdowntoward the end of the table is the best position fortheclinician todo avisual examination.Apelvicexambegins withanassessmentofthereproductiveorgans that can be seen without the use of aspeculum.Manywomenmaywantto'prepare'fortheprocedure.Douching beforetheexamisdiscouragedbecausecellsneededfromthecervixtoassessforcervical cell abnormalities maybe washed out

External examination ⚫ The pelvic exam begins with an explanation of the procedure. The woman is asked to put on an examination gown, get on the examination table, lay on her back with her feet in stirrups.Sliding down toward the end of the table is the best position for the clinician to do a visual examination. A pelvic exam begins with an assessment of the reproductive organs that can be seen without the use of a speculum.Many women may want to 'prepare' for the procedure.Douching before the exam is discouraged because cells needed from the cervix to assess for cervical cell abnormalities may be washed out

ExternalexaminationOnepossiblereasonfordelayinganexamisifitistobedone during menstruation,but thisis a preferenceof somewomenandnotarequirementoftheclinician.The woman will probablywill be asked toput on an examination gown and lay down on theexamination table.Agirl orwomanmayasktohaveanotherwoman intheexamination room duringtheexam.Theclinicianmaywanttoperformpelvicexamination and assessmentofthevagina becausethereareunexplainedsymptomsofvaginaldischarge,pelvicpain,unexpectedbleeding,orurinaryproblems

External examination ⚫ One possible reason for delaying an exam is if it is to be done during menstruation, but this is a preference of some women and not a requirement of the clinician.The woman will probably will be asked to put on an examination gown and lay down on the examination table.A girl or woman may ask to have another woman in the examination room during the exam. The clinician may want to perform pelvic examination and assessment of the vagina because there are unexplained symptoms of vaginal discharge, pelvic pain, unexpected bleeding, or urinary problems

ExternalexaminationThetypical externalexaminationbegins withmakingsurethat awomanis inacomfortableposition andherprivacyrespectedIfa woman is obese,different positioning andassistance may be requiredto keep tissue fromblocking the view of the perineal area.[3]Thepubichairis inspected forpubic liceandhairgrowthpatterns.Sparsehairpatterns canexist inolder and insomeAsianwomen.[3]

External examination ⚫ The typical external examination begins with making sure that a woman is in a comfortable position and her privacy respected. ⚫ If a woman is obese, different positioning and assistance may be required to keep tissue from blocking the view of the perineal area.[3] ⚫ The pubic hair is inspected for pubic lice and hair growth patterns. Sparse hair patterns can exist in older and in some Asian women.[3]

ExternalexaminationThelabia majora areevaluated.Theirposition and symmetry are assessed. Theexpected finding in older women is that thelabia majora can bethinner and smaller.Theexaminerislookingforulcers,inflammation.warts andrashes.Ifdrainage is presentfromthese structures, its colorlocation and othercharacteristics are noted.Infection controlisaccomplished by frequent glove changes.[3]

External examination ⚫ The labia majora are evaluated. Their position and symmetry are assessed. The expected finding in older women is that the labia majora can be thinner and smaller. The examiner is looking for ulcers, inflammation, warts and rashes. If drainage is present from these structures, its color, location and other characteristics are noted. Infection control is accomplished by frequent glove changes.[3]

Externalexamination. The labia minora are then evaluated. Theyshould appear moist, smooth in texture andpink.The presence of tearing,inflammationand swelling is noted.Thinner and smallerlabia minora are an expected finding inolderwomen.The clitoris is assessed forsize,positionsymmetry, and inflammation.[3]

External examination ⚫ The labia minora are then evaluated. They should appear moist, smooth in texture and pink. The presence of tearing, inflammation and swelling is noted. Thinner and smaller labia minora are an expected finding in older women.T ⚫ he clitoris is assessed for size, position, symmetry, and inflammation.[3]

Externalexamination.Theurethral opening is inspected.No urineshould leak whenthe womanis askedtocough.Urineleakage may indicate stressincontinence andthe weakening ofpelvicstructures.The opening should be midlinepink, and smooth.The presence ofinflammation,ordischargewhichmayindicate an infection.Excoriation canbepresent in obese women due to urinaryincontinence.[3]

External examination ⚫ The urethral opening is inspected. No urine should leak when the woman is asked to cough. Urine leakage may indicate stress incontinence and the weakening of pelvic structures. The opening should be midline, pink, and smooth. The presence of inflammation, or discharge which may indicate an infection. Excoriation can be present in obese women due to urinary incontinence.[3]