Gynaecological investigation & Procedures

History:
 C/o
 Past medical and surgical history
 Vaginal discharge
 LMP, menses
 Infection:
Sexually transmitteddiseases: E.g. Herpes simplex virus
(HSV), syphilis, gonorrhoea, Chlamydia, (HIV), (HPV)
Pelvic inflammatoryDisease (PID)
 Obstetric history (G_P_)
 Breast history

Abdominal exam

Inspection of external genitalia

Bimanual examination

Speculum examination (see /obtain vagina+cervix specimen, e.g HVS or Pap
smear

Papanicolaou smear(Pap smear): Screen for cervical cancer
Specimens are collected from 3 sites:
 vaginal pool or the posterior fornix of vagina
 cervix
 endocervix
 Do not obtain during menses, or with heavy infectious discharge
 Avoid douching, vaginal suppository or sexual intercourse at least 24 hours
before taking the smear

Abdominal USG
See any mass (e.g.Uterine fibroids), differentiate solid from cystic lesion
(e.g.ovarian cyst), confirming pregnancy
 Preparation: inform patient to drink water and not to void to make the
uterus easier to visualize
Laboratory examination

urethra, cervix,external os or high vagina swab X microscopy, cultures &
sensitivity test e.g. Candidae, Trichomonas, Gonorrhea cultures

Pregnancy test (PT):
Serum /Urine test of (HCG)
 Appears in blood and urine~14-26 days after conception
Vaginal packing
Purposes

stop bleeding

keep absorb discharge & blood
Aftercare:
 Bed rest
 usually removed on the next day, should not be keep in vagina more than
48hours
Aftercare for removal of vaginal packing:
 After removal, perform a per vaginal examination.
 Douching & vulval toilet
 Documentation
Vaginal supportive pessaries
Purposes:

correct retroversion of uterus

treat uterine prolapse especially for elderly women or those who are too ill to
tolerate surgery.

Act as temporary measures for uterine prolapse before elective surgery