Or

"Bilateral spotty inguinal adenopathy. External genitalia without ery- Suggests bacterial vaginosis. thema or lesions. Vaginal mucosa and cervix coated with thin white homogeneous discharge with mild fishy odor. After swabbing cervix, no discharge visible in cervical os. Uterus midline; no adnexal masses. Rectal vault without masses. Stool brown and hemoccult negative."

*U.S. Preventive Health Services Task Force: Guide to Clinical Preventive Services, 2nd ed. Baltimore, Williams & Wilkins,_pp. - .

Important Areas of Examination

External Examination

Internal Examination

■ Mons pubis

■ Vagina, vaginal walls

■ Labia majora and minora

■ Cervix

■ Urethral meatus, clitoris

■ Uterus, ovaries

■ Vaginal introitus

■ Pelvic muscles

■ Perineum

■ Rectovaginal wall

Many students feel anxious or uncomfortable when first examining the genitalia of another person. At the same time, patients have their own concerns. Some women have had painful, embarrassing, or even demeaning experiences during previous pelvic examinations, while others may be facing their first examination. Patients may fear what the clinician will find and how these findings may affect their lives.

The woman's reactions and behavior give important clues to her feelings and to attitudes toward sexuality. If she adducts her thighs, pulls away, or expresses negative feelings during the examination, you can gently confront her as you would during the interview. "I notice you are having some trouble relaxing. Is it just being here, or are you troubled by the examination? ... is anything worrying you?" Behaviors that seem to present an obstacle to your examination may become the key to understanding your patient's concerns. Adverse reactions may be a sign of prior abuse, and these issues should be explored.

A patient who has never had a pelvic examination is often unsure of what to expect. Try to shape the experience so that she learns about her body and the steps of the pelvic examination, and becomes more comfortable with them. Before she undresses, explain the relevant anatomy with the help of three-dimensional models. Show her the speculum and other equipment and encourage her to handle them during the examination so that she can better understand your explanations and procedures. It is especially important to avoid hurting the patient during her first encounter.

Indications for a pelvic examination during adolescence include menstrual

Sbnormalities such as amenorrhea, excessive bleeding, or dysmenorrhea, un-xplained abdominal pain, vaginal discharge, the prescription of contraceptives, bacteriologic and cytologic studies in a sexually active girl, and the patient's o wn desire for assessment.

egardless of age, rape merits special evaluation, usually requiring gyneco-gic consultation and documentation.

Bacterial Vaginosis Facts

Bacterial Vaginosis Facts

This fact sheet is designed to provide you with information on Bacterial Vaginosis. Bacterial vaginosis is an abnormal vaginal condition that is characterized by vaginal discharge and results from an overgrowth of atypical bacteria in the vagina.

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