How to examine a womans vagina and womb

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A pelvic exam is a way to learn what is happening inside a woman's vagina and womb.

Doing a pelvic exam can help you learn:

• if a woman is pregnant, and how many weeks she has been pregnant.

• if she has an infection in her womb or vagina.

• if she might have cancer of the cervix or womb.

You also must do a pelvic exam to insert an intrauterine device (see Chapter 21) or to do manual vacuum aspiration (see Chapter 23) .

This exam is not difficult to learn, and with practice, most people can do it.

A different exam can tell you if a woman's cervix is opening during labor. This chapter does not explain how to do that exam. See page 339 to learn how.

Adolescent Clitoris

^^^^^^ Note: In some places, pelvic exams are done only by doctors —

not midwives . But do not be afraid to try. With training and practice, midwives can learn this and other new skills . A midwife who learns to do pelvic exams can help women stay healthy throughout their whole lives, not just when they are pregnant or giving birth .

There are 3 parts of the pelvic exam

1. The visual exam is a way to look for any signs of infection on the outside of the woman's genitals (page 376).

2. The speculum exam is a way to see inside the woman's vagina and to test the health of her cervix. You use a tool called a speculum —>■ to do the speculum exam (page 377).

3. The bimanual exam (2-hand exam) is a way to check the health of a woman's womb and ovaries or to check the size of the womb in pregnancy. To do a bimanual exam, you feel the womb with the fingers of one hand inside a woman's vagina and the other hand on her belly at the same time (page 384).

You do not always need to do all 3 parts of this exam .

^AlfibiUAliL www.nespenan.org

When to do a pelvic exam

It is safe and useful to do a pelvic exam when:

• the woman wants to know about the health of her cervix, womb, and ovaries . You should certainly do this exam if the woman has signs of infection or cancer. But women can have infections or cancer in the cervix or womb and have no signs . So if possible, women should have this exam every few years — even if they have no signs of problems .

• the woman is pregnant and you need to know how long she has been pregnant.

• the woman is having problems after a miscarriage or abortion (see Chapter 22), and needs an MVA (see Chapter 23).

WARNING! It is not safe to do a pelvic exam when:

• the woman is in labor . It is not necessary to do a visual exam, a speculum exam, or a bimanual exam when a woman is in labor. If you must check her cervix to see if it is opening, see page 339 .

• the woman has broken waters . If the woman is pregnant and her waters are broken, this exam can spread an infection into her womb

• the woman is in late pregnancy and is bleeding from the vagina. If the woman is bleeding from the vagina in late pregnancy, she may have placenta previa (see page 112). Do not do a pelvic exam — or you could make the bleeding worse

• the woman gave birth in the last few weeks .

Making the pelvic exam safe ^

The pelvic exam is usually safe, but it can have risks. When you do . fjh a pelvic exam, you must be sure not to put any germs into the woman's vagina. When you do a pelvic exam:

• always wash your hands well, before and after the exam (see page 53).

• always wear very clean or sterile plastic gloves (see page 54).

If you cannot wash your hands or wear gloves, it is not safe to do the exam .

There may be other ways to get information about a woman's health if you cannot make a pelvic exam safe, or you do not know how to do a pelvic exam, or the woman does not want a pelvic exam

For example, to find out if a woman has an infection in her womb, start by asking her if she has any signs of infection (see page 325) and by taking her temperature. You can also try pressing on her belly, just above her pubic bone . If she has a womb infection, this will be very painful . These are safe ways to find infection because you do not have to put your fingers into a woman's vagina to do them .

Before the exam Help the woman relax

The pelvic exam is easier and more comfortable when the woman is relaxed and not afraid .

Explain what you are doing and why you are doing it . Remind the woman to take deep breaths and to let her body relax. Go slowly, and stop if you are hurting her. If the woman is healthy, the exam should not hurt. Pain can be a sign of infection or a sign that you need to be more gentle.

Fear

Tell me anytime if you feel upset or scared, and we'll stop the exam.

All right.

Some women are afraid to have pelvic exams, such as women who have never had pelvic exams, and women who have had exams that were painful .

Women who have been abused sexually or physically may have an especially difficult time having pelvic exams These women have been touched when and where they did not want to be touched With all women, and especially with women who have been abused, ask before you touch

Shame

When you do a pelvic exam, you are examining a woman's genitals and vagina. Many women are embarrassed or ashamed about these parts of their bodies . They may not want to talk about them, look at them, or let other people look at them

These body parts are an important part of being a woman . When you do a pelvic exam, encourage the woman to ask questions, and explain that these parts of her body are healthy and normal . You may not be able to take away a woman's feelings of shame, but you can help reduce them .

Tell me anytime if you feel upset or scared, and we'll stop the exam.

All right.

Ask the woman about her history

Before you do a pelvic exam, ask the woman when she had her last monthly bleeding, if she is pregnant, and if she has any signs of infection in her vagina or womb . Chapter 7 suggests other questions you can ask a woman about her health history.

Also, explain to the woman what you are going to do during the pelvic exam and answer any of her questions about it

The pelvic exam

Before you start:

• Make sure that you have privacy .

• Prepare all the tools you will need for the exam:

light mil clean or sterile speculum clean or sterile plastic gloves clean or sterile plastic gloves clean cloths for wiping after the exam clean cloths for wiping after the exam

The speculum and gloves should be sterile if you are doing a pelvic exam to insert an IUD or to do an MVA. Otherwise, a very clean speculum is OK.

Ask the woman to urinate before the exam. This will make the exam more comfortable for her.

Ask the woman to remove her pants or pull up her skirt. If she wants something to cover her legs, give her a sheet or cloth.

Ask her to lie on her back with her knees up and her buttocks at the end of the table or bed.

• Wash your hands with clean water and soap. Your fingernails should be short and clean

• Put clean plastic gloves on your hands .

The visual exam

The skin on the genitals should be smooth and healthy The genitals should be clean, but some clear or white discharge from the opening of the vagina is normal

Look for lumps, swelling, unusual discharge, sores, or scars on her genitals . Sometimes you can feel lumps with your fingers that you cannot see Lumps or sores could be signs of infection or injury. (See Chapter 18 to learn more about infections of the genitals . )

opening of vagina opening of vagina

healthy genitals

Sores on the genitals can be a sign of infection.

healthy genitals

Sores on the genitals can be a sign of infection.

The speculum exam

A speculum is a tool for looking inside a woman's vagina. The speculum holds the walls of the vagina open . When it is in the right position, you will be able to see the cervix, test for infection or cancer, insert an IUD, or empty the womb .

Practice opening and closing a speculum a few times before you use one for an exam so that you are comfortable with how it works

Some midwives let a woman look at a speculum before they give her an exam . This can help the woman understand the exam .

1. Help the woman relax by touching her leg, asking her to breathe, and by being gentle and slow . Remind her to tell you if the speculum hurts and stop the exam if you hurt her .

2. Warm the speculum with clean warm water, or by holding it in your gloved hand

3. Ask the woman if she is ready to start. When she is ready, gently open the lips of her genitals with one hand so that you can see the opening of her vagina . Make sure to explain everything you are doing as you do it .

speculum

screw 1

bills

thumb y/r^ rest —Z/ /

(you do not (J need to use \J this screw)

| A medium-sized hand|e speculum will ' work well on sS most women.

A smaller speculum may work best for young women, women who have never had sexual intercourse, older women who are in menopause or who are not having regular sexual intercourse, or women who have had FGC (see page 367). A larger speculum may work best for women who have had many children.

4. Hold the speculum with your other hand Turn the handle to one side, and slide the closed bills into the vagina . If you are gentle, the bills will slide downwards into the vagina and should not hurt the woman

How Push Vagina

As you put the speculum in, turn it so the handle is down . Be very careful not to pull her skin or hairs . Gently push the speculum all the way in . The handle should rest against the skin between the vagina and the anus .

^ Note: If the woman is on a bed or a flat table and the speculum handle will not fit facing down, you can insert it with the handle pointing up

5. Open the bills of the speculum by gently pushing the thumb-rest with your thumb . When you see the cervix between the bills, tighten the screw on the thumb-rest to keep the speculum open .

If you open the speculum but you do not see the cervix, close the speculum and remove it partway. Then try again, repeating step 4 . The cervix may be off to one side a little This is normal . Sometimes the cervix will come into view more clearly if the woman coughs or pushes down as if she is passing stool while the speculum is open inside her

The cervix is usually about this big.

cervix (opening of womb)

The Vigena

cervix (opening of womb)

The cervix is usually about this big.

6. Look at the cervix — it should be smooth and pink, or, if the woman is pregnant, a little blue

Small, smooth bumps on the cervix are usually normal, but sores or warts are signs of infection .

Notice if there is discharge or blood coming out of the cervix. Thin, white, or clear discharge is usually normal and healthy. Green, yellow, gray, lumpy, or foul-smelling discharge can be a sign of infection .

7. If the woman wants to look at her own cervix, you can hold a mirror and a light to help her see. This is a chance for a woman to learn more about her body.

8. Test the cervix for signs of cancer by using either the vinegar or Pap test (see page 379).

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9. To remove the speculum, pull it toward you a little until the bills are away from the cervix. Loosen the screw on the thumb-rest and gently let the bills close while pulling the speculum down and out of the vagina. The bills should be closed all the way as you finish pulling it out.

10. Give the woman a clean cloth or tissue to wipe any discharge from her genitals.

11. Be sure to clean the speculum after you use it.

Tests for infections and cancer

An important reason to do a speculum exam is to test the health of the cervix. The cervix can be tested for infections (see Chapter 18) and for cancer . Your local health authority may be able to provide you with kits to test for chlamydia, gonorrhea, or other STIs and can recommend how often to test women for infections and cancer. Women who have had normal exams may be tested every 3 years or when you see them during pregnancy Women whose exams were not normal should be tested more often Women with signs of illness should be tested right away

There are 2 tests for cancer of the cervix . You do not need to do both tests . Choose the test that you can use most easily in your area.

The vinegar test

The vinegar test is easy to do, it is not expensive, and you do not need to have a laboratory to know the results. If a woman has cancer on her cervix, the vinegar test ^ is very likely to find it.

But the vinegar test cannot tell how severe a cancer is, and sometimes it shows a problem that is not cancer or or

The Pap test

The Pap test can give you much more information than the vinegar test. The Pap test can tell you whether a problem on the cervix is an infection or cancer. It may tell you what type of infection a woman has, or how severe a cancer is.

But the Pap test is expensive, and you need a laboratory to know the results

If either test is positive, the woman needs medical attention as soon as possible

You can do these tests for a woman at almost any time, including when she has her monthly bleeding or during pregnancy. During a woman's monthly bleeding is not the best time to do the Pap test, because the blood can make the test less clear But it is better to do the test during a woman's monthly bleeding than not to do the test at all . If the woman is having her monthly bleeding, use a long swab to gently wipe the blood away from her cervix before you do the test

Vinegar test for HPV

Many people are infected with a sexually transmitted virus called human papilloma virus (HPV). Women get HPV when they have sex with someone who has it. Some types of HPV cause genital warts . Other types of HPV can cause cancer in the cervix. Most women with HPV have no warts and no other visible signs of the virus . See page 333 for more about HPV. If a woman has one of the dangerous types of HPV for a long time, it may cause cancer of the cervix which can lead to death Testing for HPV and removing cancer cells from the cervix can save women's lives.

The vinegar test is a very simple way to check if the woman has HPV on her cervix. A positive vinegar test shows sores on the cervix that are usually not visible These sores could be caused by HPV, cancer, or other sexually transmitted infections .

1. Insert a speculum and look at the cervix

2. Hold a sterilized piece of gauze or cloth with a sterilized pair of forceps or long tweezers . You can also use a long swab if you have one

3. Dip the gauze into plain white vinegar (any vinegar can work, as long as it has 4% to 5% acetic acid) and wet the cervix with the vinegar. Remove the gauze. The vinegar should not hurt the cervix but it may sting a little

4. Wait for 1 minute . If the woman is infected with HPV, white patches will usually appear on the cervix.

If the woman has white patches, she needs care right away from a medical center . She may be given more tests, or she may have the sores frozen or removed so they do not grow into cancer.

Pap test for infections and cancer

For a Pap test, you will scrape a tiny bit of tissue from the cervix and vagina, and put it on a thin piece of glass called a slide . To do a Pap test, you must have access to a laboratory At the laboratory, trained people must look at the tissue under a microscope to know if it is healthy or not.

Before the test, gather these supplies:

spatula long swab or cytobrush glass slide fixative long swab or cytobrush

1. Insert a speculum .

2. Place the end of the spatula that has 2 points onto the cervix and roll it in a full circle between your thumb and forefinger.

As you roll the spatula, gently scrape a very thin layer of tissue off the cervix. This should not hurt the woman, but sometimes it is uncomfortable for her It is normal for the cervix to bleed a little .

3. Wipe the spatula onto one end of the slide .

Disegno AllungamentiCytobrush Scrape

4. Place the other end of the spatula just underneath the cervix where it meets the vagina. Gently scrape sideways once.

5. Wipe the spatula onto the middle of the slide, next to the first sample .

Materiales Papanicolau

6. Put the tip of the swab or cytobrush about 1 centimeter into the opening of the cervix Gently roll it in a full circle This can be uncomfortable for the woman, but it is not dangerous

7. Wipe the swab onto the end of the slide that has not been used, next to the second sample

8. Put a fixative on the slide .

There are many fixatives available, but the least expensive is medical alcohol (95% ethyl alcohol). Pour some medical alcohol into a small jar and dip the slide into the jar of alcohol as soon as you have finished wiping the swab onto the slide. You must do it quickly, before the tissue dries . Let the slide sit in the medical alcohol for a few minutes, and then let the slide dry in the air. If you do not have medical alcohol, you can spray the slide with hairspray.

You must use a fixative on the slide or the thin layer of tissue from the cervix will smear or come off and the test will not be accurate .

9. Take the slide to a laboratory that can examine Pap tests (not all laboratories can). Take the slide within a week after doing the test .

• Note: Tell the woman that a little bleeding from the vagina is normal after a Pap test.

Cancer of the cervix

Cancer of the cervix can be a deadly disease, but if it is treated early, it can usually be cured . Treatment is simple in the early stages . A trained doctor or nurse can remove or destroy the diseased parts of the cervix in a medical center if they have the right tools . After the diseased parts of the cervix have been removed, the woman will usually get better. But hundreds of thousands of women die every year from this cancer.

Why do so many women die if the disease is preventable and easily treated?

• Poor communities cannot afford to train health workers to test or treat women for HPV, a common cause of cancer of the cervix.

• Rural and poor women may not be able to travel to distant medical centers that give testing and treatment .

• Women and men do not know that they can prevent cancer of the cervix by protecting themselves from HPV. For example, wearing condoms can prevent women and men from getting HPV.

• Some women cannot protect themselves from HPV because they do not have access to condoms . Some women cannot protect themselves because they are forced to have sex or to have unsafe sex Some couples do not like to use condoms

The bimanual exam (2-hand exam)

Feel the womb with 2 hands to check for infections or growths, or to learn how long a woman has been pregnant. To feel the womb, you will need:

very clean or sterilized plastic gloves very clean or sterilized plastic gloves water-based lubricating jelly like K-Y Jelly, or clean water (do not use oil or petroleum jelly)

Ask the woman to urinate before you start

1. Have the woman lie on her back with a pillow under her head. As you examine her, explain everything that you are going to do before you do it, remind her to relax, and stop the exam if she is in pain

Midwives Examine

2. When the woman is ready, put on gloves and put some lubricating jelly on the first 2 fingers of your right hand (or your left hand if you are left-handed) .

Ask the woman to take a deep breath to help her relax. Gently open the lips of her genitals with your left hand. With the palm of your right hand facing up, put your two lubricated fingers all the way into the woman's vagina.

3. Feel the cervix with your fingertips .

The cervix should be firm, round, and smooth . Normally, it feels about as hard as the tip of a nose . In the last months of pregnancy it feels soft, like lips Sometimes at the end of pregnancy the cervix is a little open If the woman has just had a miscarriage or an abortion, her cervix might be open .

The cervix can be hard to find . If you cannot feel the cervix, ask the woman to cough or push down as if she were passing stool until the cervix touches your finger. It may also help if the woman lies more flat.

Take care not to touch the woman's clitoris, which is sensitive, or her anus, which has germs on it. Your thumb can easily touch the clitoris accidentally, so keep it to one side

4. Check for pain in the cervix .

Put one of your fingers on each side of the cervix and move it side to side . This might feel strange to the woman, but it should not hurt. If it hurts, she might have an infection in her womb (see page 325) or a tubal pregnancy (see page 113). These are both very dangerous . If the cervix feels soft and is easy to move, the woman may be pregnant .

5. Put your left hand on the woman's belly, below her navel (bellybutton) and above the hair around her genitals. ' ; This is how a bimanual exam would look if you could see the inside of a woman's body.

Cervix Checking Photo

Press on the belly with the outside hand.

Put the 2 fingers that are in the vagina under the cervix. Lift up the cervix and womb with those 2 fingers At the same time, press down on the woman's lower belly with your left hand Try to feel her womb between your hand and your 2 fingers You will know that you are pressing on the womb when you feel the cervix move. If you do not feel the womb at first, try moving your hand around on her belly and pressing down in different places

Feeling the womb takes practice . It is especially difficult to feel a woman's womb if she has strong belly muscles or if she has a lot of fat on her belly.

Press on the belly with the outside hand.

Assessment Fetal Head Station
Lift the cervix and womb with 2 fingers.
Finger Cervix

To measure the womb after 12 weeks, see page 130 .

You might feel lumps or growths on the womb Some growths are not dangerous, but they may cause pain, heavy monthly bleeding, or bleeding between monthly bleedings . They are called fibroids . Other growths may be cancer of the womb . You cannot be sure the growths are not dangerous until the woman has more tests If you feel growths on the womb, get medical help

8. Feel the ovaries .

Finding and feeling the ovaries can be very difficult . It takes a lot of practice .

Put both your inside fingers on one side of the cervix and lift up the ovary. Move your outside hand to the same side of the woman's body as the inside fingers and slide your outside fingers down her belly. When you press hard, you can feel her ovary slip between your fingers

You must push down deeply with your outside hand, so ask the woman to take a deep breath and let it go before you feel her ovary. Stop pushing if she is in pain!

An ovary is usually about this big.

An ovary is usually about this big.

3 cm

3 cm

Checking The Womb

After checking one side, move your hands to check the other ovary.

If you feel something bigger than 3 centimeters long and 2 centimeters wide, or if this exam hurts her a lot, she might have a growth on her ovary, or she might have a tubal pregnancy (see page 113) . Get medical help .

Note: It is normal for a woman's ovary to get bigger and smaller every month . If you are not sure of the cause of a large ovary, try checking again in 6 weeks . It may be small again .

9. Take your fingers out of her vagina . Hold the lips of her genitals open and ask her to cough or push down as if she were passing stool Watch her vagina to see if anything bulges out If it does, she could have a fallen womb or bladder, or part of her bowel could be bulging into the vagina . Get medical advice .

What Does Fallen Bladder Look Like
a fallen bladder

After the bimanual exam, give the woman a clean cloth or paper to wipe off the jelly. Explain to her that she will have some extra discharge (the jelly) or a little blood after the exam .

Tell the woman what you found during the pelvic exam . Make sure to answer any questions the woman has .

Chapter 21 How to insert an IUD

In this chapter:

Help a woman decide if the IUD is right for her 390

Before you insert the IUD

Inserting the IUD

Loading the Copper T IUD 393

After you insert the IUD

To check the IUD 398

Removing the IUD

391

392

398

Signs that something might be wrong 398

399

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Pregnancy Guide

A Beginner's Guide to Healthy Pregnancy. If you suspect, or know, that you are pregnant, we ho pe you have already visited your doctor. Presuming that you have confirmed your suspicions and that this is your first child, or that you wish to take better care of yourself d uring pregnancy than you did during your other pregnancies; you have come to the right place.

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  • ethel pearson
    When u are 2 month preg y'r womb is open or closed?
    4 years ago
  • Noora
    How to examine a vagina?
    4 years ago
  • emmi
    How to place a speculum?
    4 years ago
  • alfredo
    How to examine her genitals?
    4 years ago
  • niklas
    What is the device used to examine a woman's vagina?
    3 years ago
  • Lassi
    Where do doctors place copper T in womb?
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  • ANGELICA LOTHRAN
    Is it normal for a womb to come near vagina during pregnant?
    3 years ago
  • alexander
    How to insert misoprostol using the finger?
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  • AINO
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  • abela
    How can a woman check her womb?
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  • Dehab
    How to examine vagina in doctor?
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  • settimo mazzi
    Is it proper for a midwife to dip her hand into the vaginal to examine the cervix?
    2 years ago
  • stefanie
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    How to exam your vagina?
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  • christina
    Does doctor put hand inside vigina?
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  • alexander jones
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    Can see a proper picture of the round ball in my vigina?
    2 years ago
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    2 years ago
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    How to insate hand in pregnat woman vigena?
    2 years ago
  • janina
    Is a woman womb inside or outside the viginal?
    2 years ago
  • Ahti
    How to place the spatula inside the vagina?
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  • abrha
    How to examine vagina at home?
    11 months ago
  • lucas
    What is the device called that opens a womens vagina at the doctor?
    10 months ago
  • Marissa
    How do look a vagaina?
    8 months ago
  • cornelia twofoot
    What does a normal vag look like outside pictures?
    8 months ago
  • geneva anderson
    How does a woman examine a member of medicine?
    6 months ago
  • ronnie
    Can i tell hpv by physically looking at a womans vagina?
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