Saturday, January 15, 2011

First pelvic exam is embarrassing to many girls, and so avoid reporting of infections and pain in their reproductive organs.

First pelvic exam is embarrassing to many girls, and so avoid reporting of infections and pain in their reproductive organs. During pelvic examination, the girl is asked to be comfortable in partial sleep mode at the very edge of the exam table, with her feet in stirrups, knees bent and relaxed out to the side. If she is not down far enough, the exam will be more difficult and more uncomfortable for her. The stirrups are padded to avoid the stirrups digging into her feet, any soft padding material can be used. The images are shown below for better understanding.

Teen girls may have never shown their private parts / genitals till now to any doctor. Even her genitals are not shown to any females including her mother. The mother daughter relationship should be like very very close friends, so that all private issues related to reproductive system can be discussed and examined freely. Mothers of pubertal daughters are advised to do so to build the healthy personal relationship with daughter to educate her on every information of human reproduction according to daughter's age.

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The vulva and all private parts are only seen by female gynecologist, so nothing to worry even if it is first pelvic exam. Such pelvic vaginal cervix examinations will be a part of female's routine healthcare in years to come. Your female Gynecologist will have view of your complete vulva under bright light.
As such one can compare the lips of mouth with Labia, Tounge with inside of vagina /cervix and mucus or saliva with vaginal secretions. Inside of mouth remains wet 24X7, similarly inside of vagina remains moist 24X7. It does carry healthy bacterias. So specific odor, wetness and staining is normal. Vagina remains wet similar to tongue and mucus.

What the female Gynecologist will do is explained as under:
Inspect the vulva first. Look within the pubic hair for the tiny movement of pubic lice. May be thenafter pubic hair needs to be shaved off. Some gynecologist will insist that you come with complete shaving of pubic hair or otherwise her nurse will shave the pubic hair for better inspection of vulva. They use a bright light to visually inspect the vulva, vagina, uretha, and cervix. Most examiners find it easy to look just over the light to get the best view. Separate the labia with gloved fingers to look for any surface lesions, redness, or swellings.

Look on the labia for the cauliflower-like bumps that are known as venereal warts. Using magnification (magnifying lenses or colposcope) is very useful when the patient has vulvar complaints and the diagnosis is not obvious.

Look between the folds of skin for ulcerative lesions that can indicate an active herpes infection. Gently retract the clitoral hood back, exposing the clitoris while looking for peri-clitoral lesions Look for the hymen or remnants of the hymen and identify any redness just exterior to the hymen that can indicate vulvar vestibulitis.

Hymen may be present or absent is normal. Hymen is a thin skin having small holes to pass the menstruation blood, clot and vaginal secreations.
The periurethral glands have tiny ducts that open onto the surface. Look for them next to the urethra. While looking at the urethra, note any discharge coming from the urethral opening that might suggest gonorrhea or chlamydia. Uretha is a very tiny hole and only urine comes out. Nothing goes inside uretha. so need not to worry. Vaginal hole is wider and can be seen.Outer labia can be stretched. pics outer labia streached uretha clitoris
Palpate the upper labia majora for masses related to hernias extending through the Canal of Nuck. Palpate the middle and lower portion of the labia majora for masses suggesting a Cyst.Sebum, a white semi liquid, thick substance generally noticed by many girls during puberty and thenafter through the adult life. This sebum may stain panty crotch. the sebum is generally normal unless it is infected and one feels itchy as well as it has a foul smell.

pics teen girl white sebum will stain panty
pics teen girl white thick sebum from vagina
pics teen girl normal white yellow secreation
pics infection at root bottom of outer labia
pics Insert Speculum through labia in vagina for pelvic exam by gynecologist.jpg
pics Vagina inside view with speculum use during pelvic examination.jpg

Warm and lubricate the speculum with warm water.

After warming a vaginal speculum with warm water, separate the labia with one hand while gently inserting the speculum with the other hand. It is frequently more comfortable for the girl patient if you insert the speculum rotated about 45 degrees (so the blades are not horizontal but are oblique). Once past the introitus, rotate the speculum back to it's normal position.
In very rear cases the vaginal opening is so small and labia majora is almost absent in preteens girl. Every mother should have noticed this that the puberty development of vulva, vagina and labia is normal for her daughter. This may require mother to inspect and examine at least twice in a year for the pubertal / teenage daughter. if any abnormality is seen, please report to gynecologist for further consultation.
pics abnormal small vagina opening before n after surgery

The labia, particularly the labia minora, are very sensitive to stretching or pinching, so try not to catch the labia minora in the speculum while inserting it. Gynecologists may ask the girl to "bear down" while they are inserting the speculum and feel that this assists with insertion.

Turning hand palm up, compress the urethra against the underside of the pubic bone. Normally, this doesn't hurt. If it causes discomfort for the patient, it is likely that at least some degree of urethritis is present.

Then insert rubber gloved fingers deeper into the pelvis. Due to contaction the vaginal hole may become tight and increase friction result into pain. So patient have to relax the body and pelvic muscles for easy insertion of gloved fingers. Keeping palm up, curl vaginal finger(s) up, compressing the bladder against the back of the pubic bone. Normally, this pressure creates the sensation that the patient needs to urinate, but is not painful. If it is painful, this is good clinical evidence of cystitis (urinary tract infection), or (less likely) endometriosis.
Obtain specimens for a Pap smear and any cultures that may be indicated.
pics cervical examination pap smear extraction for lab test.

Cervix cancer is a risk and so CERVIX examination is always necessary. Cervix is deep inside the vagina and feel like a finger or thumb. It has one very tiny opening to pass the menstruation blood, dead cells of uterus and liquid secreations. It also allows male sperm to pass from vagina to uterus after ejaculation in vagina from the penis of the husband. The cervix opening and surface should not be damaged by any means. Gynecologist wear rubber gloves to avoid any touch / friction of their nails. Also speculum have smooth surface and gynecologist is experienced to use it.

But teenage girls and young females should never insert finger without rubber gloves even for masturbation. Never ever insert any object inside vagina for masturbation, which may damage the cervix and inner skin of vagina. Even married females should feel that cervix is not get damaged with agressive insertion and motion of her husband's penis during intercourse.

pics even your nails can cut skin cervix inner labia hymen
pics damaged cervix opening inside vagina due to solid insertion...
pics cervix view in vagina using speculum .. ..
pics cervix and fluid in vagina .. ..
pics cervix cancer risk
pics cervix cancer
pics clitoris uretha vagina labia
pics perinium anus skin problem below labia.jpg

For a normal examination:
External genitalia are of normal appearance.
There is no enlargement of the glands.
Urethra and bladder are non-tender.
Vagina is clean, without lesions or discharge
Cervix is smooth, without lesions. Motion of the cervix causes no pain.
Uterus is normal size, shape, and contour. It is non-tender.
The adnexa (tubes and ovaries) are neither tender nor enlarged.
pics teenage healthy labia clitoris hymen inside view vagina.jpg
pics deep inside view of vagina as seen with help of Spatula.jpg
pics whitish creamy vaginal cervical fluid secreation
During the bimanual exam, you may use one finger or two fingers inside the vagina. Two fingers allows for deeper penetration and more control of the pelvic structures, but one finger is more comfortable for the patient.
In some gitls, particularly those with difficult to feel pelvic masses, a combined rectovaginal exam is useful. Change gloves, lubricate the rectum, and then gently insert your index finger into the vagina and your middle finger into the rectum. The rectovaginal exam is helpful in feeling the uterosacral ligaments, a common site of endometriosis involvement. On completion of the rectal exam, stool can be checked for the presence of occult blood.

If the hymen is intact, it may still be possible to perform a comfortable and complete exam, but if the exam is causing too much pain, stop the exam and consider these alternatives:Rectal exam with the index finger can often provide the information needed by the gynecologist at that time. Exam under anaesthesia will provide full access without causing pain to the patient. Ultrasound scan, abdominally and trans-perineal, can sometimes provide you with the information you need.


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