Vagina and cervix examination

Vagina and cervix

1. Inspection of the vagina and cervix using a speculum should always precede palpation.
2. The instrument should be warmed with tap water, vaginal or cervical smears are to be obtained for the test or if cultures are to be performed.
3. Select the proper size of speculum (Fig. 1.2), warmed and lubricated (unless contraindicated). Introduce the instrument into the vaginal orifice with the blades oblique, closed, and pressed against the perineum. Carry the speculum along the posterior vaginal wall, and after it is fully inserted, rotate the blades into a horizontal position and open them. Maneuver the speculum until the cervix is exposed between the blades. Gently rotate the speculum around its long axis until all surfaces of the vagina and cervix are visualized.
4. Inspect the vagina for the following:

1. The presence of blood

2. Discharge. This should be studied to detect trichomoniasis, monilia, and clue cells and to obtain cultures, primarily for gonococci and chlamydia.

3. Mucosal characteristics (i.e., color, lesions, superficial vascularity, and edema)

   The lesion may be:

   1. Inflammatory, redness, swelling, exudates, ulcers, vesicles

   2. Neoplastic

   3. Vascular

   4. Pigmented, fluish discoloration of pregnancy (Chadwick's sign)

   5. Miscellaneous (e.g., endometriosis, traumatic lesions, and cysts)

4. Structural abnormalities (congenital and acquired)

5. Inspect the cervix for the same factors listed above for the vagina. Note the following comments relative to the inspection of the cervix:

   1. Unusual bleeding from the cervical canal, except during menstruation, merits an evaluation for cervical or uterine neoplasia.

   2. Inflammatory lesions are characterized by a mucopurulent discharge from the os and redness, swelling, and superficial ulcerations of the surface.

   3. Polyps may arise either from the surface of the cervix projecting into the vagina or from the cervical canal. Polyps may be inflammatory or neoplastic.

   4. Carcinoma of the cervix may not dramatically change the appearance of the cervix or may appear as lesions similar in appearance to an inflammation. Therefore, a biopsy should be performed if there is suspicion of neoplasia.