Basic gynecological examination 3rd Medical Faculty, Charles University

Gynecological examination Non – invasive: history, aspection, palpation, ultrasound, etc… Pre-bioptic examination: kolposcopy Mikrobiological examination Endoscopic methods cystoscopy, hysteroscopy, laparoscopy, etc…

History Family / genetic factors Personal - blood pressure, BMI, etc… gynecological - obstetric –Menstruation cycle –Delivery – spontaneus / S.C. –Gynecologicla disease –Contraception / hormonal therapy Status present Sexual life

Gynecological examination palpation –cervix, uterus, adnexis, cavum Douglasi, abdominal wall, small pelvis, urinary bladder - pain, resistence, peritoneal irritation In speculam –Pathology of : introitus, vulva, cervix (speculae: Simpsons, Scherbacks, Cuzks) examination per rectum –Pediatric gynecology –cervix, uterus, adnexis, cavum Douglasi Examination in anestasia / analgesia

Breast examination –shape, density, skin and nipple of the breast –palpation: 4 quadrants, nipple discharge –recommandation: self examination once a months Mamograph screening programme: from 45 years – every 24 months – event. ultrasound

Pre-bioptic examination methods Kolposcopy –Screening examination –6 - 40x (magnification) –native kolposcopy Cervical and vulvar patholgy Change of the epithelium, inflammation angiogenesis Pre-cancerosis, tumor proscess

Pre-bioptic examination methods Expanded colposcopy –Acetic acid – diferentiation of squamous and cylindric epithelium – change of the colour andtransparence –Schiller´s examination – Lugol´s dilution – squamous epithelium is brown, cylindric epithelium or erosion are non-colured

Pre-bioptic examination methods Expanded colposcopy –physiological status: squamous epithelium, ektopium, ektropium, trnasformative zone –non-physiological status: angiogenesis, glands, leukoplakia, white epithelium, mozaik, pre-carcinoma, carcinoma. –kondylomatas, papiloms etc…

Pre-bioptic examination methods Function cytology –changes of the epithelium during the menstruation cycle –diagnaotic of the mestrual cycle disorders Oncological cytology –The most important screening methods for ca cervicis –Cytological critiria of the smear from the cervix – exocervix / endocervix

Pre-bioptic examination methods Classification of the oncological cytology: –Bethesda –SIL - dlaždicobuněčná intraeiteliální léze –LSIL –HSIL –ASCUS –HPV infection

Ultrasound The most important diagnostic method Abdominal ultrasound –Pediatric gynecology –Abdominal tumors, ascites Vaginal ultrasound –Small pelvis pathology –GEU –Tumonrs ot the vary and uterus doppler

Urogynecology cystoskopy urodynamics –uroflowmetry –Uretral pressure profile uretrocystografy

Endoskopic methods Vaginoscopy Hysteroscopy Rektoscopy Laparoscopy

laparoscopylaparoscopy

Invasive diagnostic and treatment methods Dilatation of the cervix curretage Punction of the cavi Douglasi Biopsia of the cervix Biopsia of the vulva