The Small Introitus

Many virginal vaginal orifices admit a single examining finger. Modify your technique so as to use your index finger only. A small Pedersen speculum may make inspection possible. When the vaginal orifice is even smaller, a fairly good bimanual examination can be performed by placing one finger in the rectum rather than in the vagina.

Similar techniques may be indicated in elderly women in whom the introitus has become atrophied and tight.

An imperforate hymen occasionally delays menarche. Be sure to check for this possibility when menarche seems unduly late in relation to the development of a girl's breasts and pubic hair.

Two methods help you to avoid placing pressure on the sensitive urethra. (1) When inserting the speculum, hold it at an angle (shown below on the left), and then (2) slide the speculum inward along the posterior wall of the vagina.

Posterior Vaginal Wall ReactorTight Introitus

After the speculum has entered the vagina, remove your fingers from the in-troitus. You may wish to switch the speculum to the right hand to enhance maneuverability of the speculum and subsequent collection of specimens. Rotate the speculum into a horizontal position, maintaining the pressure posteriorly, and insert it to its full length. Be careful not to open the blades of the speculum prematurely.

Speculum Cervix

Inspect the Cervix. Open the speculum carefully. Rotate and adjust the Leculum until it cups the cervix and brings it into full view. Position the ight until you can visualize the cervix well. When the uterus is retroverted, e cervix points more anteriorly than illustrated. If you have difficulty findig the cervix, withdraw the speculum slightly and reposition it on a different slope. If discharge obscures your view, wipe it away gently with a large cotton swab.

Inserting SpeculumCervix Speculum

Inspect the cervix and its os. Note the color of the cervix, its position, the characteristics of its surface, and any ulcerations, nodules, masses, bleeding, or discharge.

Maintain the open position of the speculum by tightening the thumb screw.

See Table 11-3, Variations in the

Obtain Specimens for Cervical Cytology (Papanicolaou Smears).

Obtain one specimen from the endocervix and another from the ecto-cervix, or a combination specimen using the cervical brush ("broom"). For best results the patient should not be menstruating. She should avoid intercourse and use of douches or vaginal suppositories for 24 to 48 hours before the examination.

A yellowish discharge on the endocervical swab suggests a mucopurulent cervicitis, commonly caused by Chlamydia trachomatis, Neisseria gonorrhoeae, or herpes simplex (p._).

OBTAINING THE PAP SMEAR: OPTIONS FOR SPECIMEN COLLECTION

Cervical Scrape and Endocervical Brush

Cervical Scrape. Place the longer end of the scraper in the cervical os. Press, turn, and scrape in a full circle, making sure to include the transformation zone and the squamocolumnar junction. Smear the specimen on a glass slide. Set the slide in a safe spot that is easy to reach. Note that doing the cervical scrape first reduces obscuring cells with blood, which sometimes appears with use of the endocervical brush.

Endocervical Brush. Now take the endocer-vical brush and place it in the cervical os. Roll it between your thumb and index finger, clockwise and counterclockwise. Remove the brush and pick up the slide you have set aside. Smear the slide with the brush, using a gentle painting motion to avoid destroying any cells. Place the slide into an ether-alcohol solution at once, or spray it promptly with a special fixative.

Note that for pregnant women, a cotton-tip applicator, moistened with saline, is advised in place of the endo-cervical brush.

100 Pregnancy Tips

100 Pregnancy Tips

Prior to planning pregnancy, you should learn more about the things involved in getting pregnant. It involves carrying a baby inside you for nine months, caring for a child for a number of years, and many more. Consider these things, so that you can properly assess if you are ready for pregnancy. Get all these very important tips about pregnancy that you need to know.

Get My Free Ebook


Responses

  • Marcho
    How to enjoy a small introitus?
    4 years ago
  • Barry
    What is a small vaginal introitus?
    4 years ago
  • P Vasala
    What is a retroverted cervix?
    4 years ago
  • alfonso
    Which position opens the cervix?
    3 years ago
  • melanie
    What is meant by small introitus?
    3 years ago
  • Remo Greco
    How to look at your own cervix with speculum?
    2 years ago
  • Keijo Weckman
    How insert speculum to vagina?
    1 year ago
  • prisca
    How to insert vaginal Speculum?
    8 months ago

Post a comment