Summary of "Basic Gynae Examination"

Summary of “Basic Gynae Examination” Video

This video is a practical instructional session on performing a basic gynecological (gynae) examination using a pelvic model. The session covers the necessary instruments, step-by-step examination procedures, patient communication, and the use of anatomical models to understand normal and pathological findings.

Main Ideas and Concepts

Instruments for Gynae Examination

The primary instrument used is the speculum, specifically the Cusco speculum (a bivalve speculum).
Specula types:
- Disposable plastic versions (single-use).
- Reusable steel versions (require sterilization).
- Sims speculum: a single-valve speculum used mainly in operating theaters when assistance is available.
Speculum sizes are color-coded for easy identification:
- Pink: Small size, used for postmenopausal or nulliparous women.
- Yellow: Medium size, suitable for most women.
- Green: Large size, used for women with multiple vaginal deliveries or larger body size.

Patient Communication and Consent

Introduce yourself clearly to the patient.
Explain the procedure, emphasizing what will happen and addressing patient fears (e.g., pain, discomfort).
Reassure the patient that the examination might cause slight discomfort but not pain.
Inform the patient before any step that might cause discomfort.
Ensure patient privacy and comfort throughout the process.

Step-by-Step Examination Procedure

A. Preparation

Patient changes and lies flat on the examination table.
Maintain patient privacy by covering appropriately.
Perform hand hygiene before starting.

B. Abdominal Examination

Inspect the abdomen for masses, distension, or scars.
Palpate starting away from any area of pain reported by the patient.
Check for tenderness, rebound tenderness, or guarding.
Purpose: Detect large pelvic masses (e.g., ovarian cysts) that may be palpable abdominally.

C. Speculum Examination

Lubricate the speculum on both sides.
Inspect the vulva for lesions.
Gently insert the speculum after parting the labia.
Locate the cervix; adjust speculum position if necessary.
Inspect the cervix and vaginal walls for lesions, bleeding, or discharge.
Perform Pap smear using a self-retaining speculum to free one hand.
Optional procedures at this stage:
- Vaginal swabs for infection.
- Endometrial sampling if indicated.
Remove speculum gently to avoid discomfort.

D. Bimanual Examination

Apply lubrication.
Insert the index and middle fingers along the vaginal axis.
Palpate the cervix and posterior fornix.
Assess uterus size, position (anteverted), contour, masses, and tenderness.
Palpate adnexa (right and left) for masses or tenderness.
Conclude vaginal examination.

Use of Pelvic Models for Training

Models demonstrate normal uterus, tubes, and ovaries.
Pathological models include:
- Uterine fibroids (e.g., subserosal fibroid).
- Adenomyosis (globally enlarged uterus).
- Adnexal pathologies such as hydrosalpinx (enlarged fallopian tube).
- Ovarian cysts/masses of varying sizes (inflatable to simulate size changes).
Pelvic trainers help build confidence and familiarize learners with normal and abnormal anatomy before examining real patients.

Detailed Methodology / Instructions for Basic Gynae Examination

Before Examination

Introduce yourself to the patient.
Explain the examination steps and address any fears.
Ensure patient privacy and proper positioning on the examination table.
Perform hand hygiene.

Abdominal Examination

Expose the abdomen from just below the sternum to the suprapubic region.
Inspect for scars, masses, or distension.
Palpate gently, starting away from painful areas.
Observe patient’s facial expressions for discomfort.
Check for rebound tenderness and guarding if tenderness is noted.

Speculum Examination

Lubricate speculum on both blades.
Inspect vulva for lesions.
Insert speculum gently, parting labia slightly.
Locate cervix; adjust speculum as needed.
Inspect cervix and vaginal walls.
Perform Pap smear with speculum self-retaining.
Optionally take vaginal swabs or endometrial samples if indicated.
Remove speculum gently.

Bimanual Examination

Lubricate fingers.
Insert index and middle fingers along vaginal axis.
Palpate cervix, posterior fornix.
Assess uterus size, position, contour, and tenderness.
Palpate adnexa bilaterally.
Note any abnormalities or tenderness.

Post-Examination

Allow patient to dress.
Discuss findings or next steps as appropriate.

Training with Models

Use pelvic trainers with normal and pathological models.
Practice palpation and identification of abnormalities such as fibroids, adenomyosis, hydrosalpinx, and ovarian cysts.

Speakers / Sources Featured

Dr. Lee – Main instructor performing and explaining the gynae examination.
Cindy – Learner/student participating in the session and asking questions.
Mrs. Smith – Simulated patient for demonstration purposes (role-played by Dr. Lee or another actor).

This video provides a comprehensive overview of the basic gynecological examination, emphasizing patient communication, proper technique, and the use of anatomical models for training.