Well-woman examination

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A well woman examination is an exam offered to women to review elements of their reproductive health. The exam includes a breast examination, a pelvic examination and a pap smear but may also include other procedures. Hospitals employ strict policies relating to the provision of consent by the patient, the availability of chaperones at the examination, and the absence of other parties. [1] [2]

Contents

Importance

Although women often undergo well-woman examinations on an annual basis, the interval for this visit and exam will vary depending on the needs of the patient. [3] The purpose of this exam in asymptomatic women is to screen for potential abnormalities, such as sexually transmitted diseases, and malignancy. [4] [5]

Breast examination

Visual inspection

The breast examination begins with a visual inspection. With the patient in a supine or seated position, the medical professional will look at both breasts to check the color, symmetry, dimensions according to age, lean body mass, the physiological (pregnancy and lactation) and race, looking for abnormalities, such as bulges and shrinkage. [6] One of these abnormalities is changed in the areola or nipple. If it is flattened or retracted (umbilicated), it is necessary to consider the possibility of a cancerous lesion which has caused the malformation. [6] [7]

Palpation

Next, the breasts are palpated, again with the patient lying or sitting. The patient has to lift the arm and put one hand behind her head. With this position, the entire gland is palpated. It is also important to examine the armpits, because of masses that may be found there. [6] The test is executed pressing the gland with two or three fingers against the chest wall, making a radial route or by quadrants. The nipple is also squeezed check for secretions, such as secretion of milk (galactorrhea), serous, blood or purulent secretions. If a node is detected, it is necessary to determine its place, size, shape, edges, consistency and sensitivity. [6]

Self-examination

Breast self-examination is not recommended as this practice is associated with increased false positive findings and no evidence of benefit. Instead breast self-awareness is encouraged. Breast self-awareness includes being familiar with the normal contour of one's breast but does not involve monthly self-examinations. [8]

Further examination of the breasts

A mammogram or mammography is a special x-ray of the breasts. They are the procedure most likely to detect early breast cancer in asymptomatic women. Mammograms can show tumors long before they are large enough to palpate. They are recommended for women who have symptoms of breast cancer or who are at increased risk of developing the disease. They are performed with the patient standing, the breast pressed between two plastic plates, as the image is taken. The interpretation has to be performed by a specialist. [9]

Breast ultrasound is a complementary study of mammography. In many women the tissue that makes up the breast is very dense, representing fibrous tissue and glandular tissue, which produces milk during lactation. This limits the radiologist interpreting the study, so, in these cases, the ultrasound is helpful, since this is capable of distinguishing tumors in women with dense breast tissue, where identification is otherwise difficult. Additionally, it is advisable to follow up a mammogram that shows indications of tumors with an ultrasound, to confirm, before more invasive procedures are undertaken. [10]

Pelvic exam

The pelvic exam is part of the physical examination of the internal pelvic organs (uterus, cervix, ovaries), vagina, and external genitalia. This exam often includes three parts:

  1. Inspection of the external genitalia
  2. Bimanual examination
  3. Inspection of the cervix and vagina using a speculum. [11]

Inspection of external female genitalia

The patient is placed in a supine position on a special examination table, which has two protrusions called "stirrups." With the feet in these stirrups, the legs are placed in a position such that the medical professional can access the pelvic area. The external genitalia is examined first, looking for abnormalities like lesions, ulcers, warts and color changes. The elements of this exam include the vulva, which contains the mons pubis, of which there are two longitudinal folds of skin forming the labia majora; then the labia minora and hair follicles. The clitoral hood is also checked. [11]

Bimanual exam

The purpose of this exam is to palpate or feel the pelvic organs. The index and middle finger are inserted into the vagina. This maneuver allows the doctor to palpate the vagina for any deep lacerations, masses, or nodularity. Next, the cervix is palpated to check position, size, consistency, and mobility. [12] The other hand is placed on the abdomen, compressing the uterus between both hands. This maneuver allows the clinician to assess the size, shape, consistency, tilt, and mobility of the uterus. With this technique, the ovaries may also be palpable. [12] This examination is useful for identifying clinical signs of medical conditions, such as infection, [13] presence of a mass, [14] or structural abnormality. [14]

Speculum examination

The speculum is an instrument made of metal or plastic and is constructed with two flaps. Its purpose is to separate and widen the vaginal opening and keep it open. This allows direct observation by the physician into the vaginal canal with the help of a lamp or a mirror. [15] There are different types of speculums used within the different characteristics of each patient such as age, sex life, and other factors. The first step is to open the vaginal opening with two fingers at the vulvo-perineal angle, then separate the fingers slightly and press down, then insert the speculum arranging the width of the tip of the flaps in anteroposterior. Then the speculum is moved into the vagina at an angle of 45°, following the natural contour of the posterior vaginal wall. When the speculum is in place, the fingers are removed and the device is rotated so that the flaps are horizontal. The flaps are then separated and locked into place when the cervical neck is completely visible. [15] The speculum examination is not necessary for adolescents who are asymptomatic. [16]

Screening Tests

Samples for screening tests may be collected during the pelvic exam. These screening tests include:

  1. Cervical Cancer Screening - A pap smear and/or HPV testing may be performed as a screening test for cervical cancer. [17] The procedure begins by gently scraping or sampling the cells of the cervix using a special spatula, brush or swab. Some women experience temporary bleeding from this procedure. The scrapings are placed on a slide, covered with a fixative for later examination under a microscope to determine if they are normal or abnormal. [18] Depending on patient's age or pap smear result, HPV testing may also be performed.
  2. Sexually Transmitted Infection Screening - Depending on age and risk factors, clinicans may recommend gonorrhea or chlamydia testing at the time of the well woman exam. This sample can be collected via a swab of the cervix or vagina. This swab can be collected by the clinician or the patient. Urine samples can also be used for this test. Additional screening tests include blood tests for hepatitis C, HIV, and syphilis. [19]

Related Research Articles

Vagina part of the female genital tract

In mammals, the vagina is the elastic, muscular part of the female genital tract. In humans, it extends from the vulva to the cervix. The outer vaginal opening is normally partly covered by a membrane called the hymen. At the deep end, the cervix bulges into the vagina. The vagina allows for sexual intercourse and birth. It also channels menstrual flow (menses), which occurs in humans and closely related primates as part of the monthly menstrual cycle.

Obstetrics and gynaecology or obstetrics and gynecology is the medical specialty that encompasses the two subspecialties of obstetrics and gynaecology. It is commonly abbreviated as OB-GYN or OB/GYN in US English, and as obs and gynae or O&G in British English.

Gynaecology Science of the treatment of diseases of the female sexual organs and reproductive tract

Gynaecology or gynecology is the medical practice dealing with the health of the female reproductive system. Outside medicine, the term means "the science of women". Its counterpart is andrology, which deals with medical issues specific to the male reproductive system.

Mammography Process of using low-energy X-rays to examine the human breast for diagnosis and screening

Mammography is the process of using low-energy X-rays to examine the human breast for diagnosis and screening. The goal of mammography is the early detection of breast cancer, typically through detection of characteristic masses or microcalcifications.

Colposcopy

Colposcopy is a medical diagnostic procedure to examine an illuminated, magnified view of the cervix as well as the vagina and vulva. Many pre-malignant lesions and malignant lesions in these areas have discernible characteristics that can be detected through the examination. It is done using a colposcope, which provides a magnified view of the areas, allowing the colposcopist to visually distinguish normal from abnormal appearing tissue and take directed biopsies for further pathological examination. The main goal of colposcopy is to prevent cervical cancer by detecting and treating precancerous lesions early. The procedure was developed by the German physician Hans Hinselmann, with help from Eduard Wirths. The development of colposcopy involved experimentation on Jewish inmates from Auschwitz.

Dyspareunia is painful sexual intercourse due to medical or psychological causes. The pain can primarily be on the external surface of the genitalia, or deeper in the pelvis upon deep pressure against the cervix. It can affect a small portion of the vulva or vagina or be felt all over the surface. Understanding the duration, location, and nature of the pain is important in identifying the causes of the pain.

Cervicitis is inflammation of the uterine cervix. Cervicitis in women has many features in common with urethritis in men and many cases are caused by sexually transmitted infections. Non-infectious causes of cervicitis can include intrauterine devices, contraceptive diaphragms, and allergic reactions to spermicides or latex condoms. Cervicitis affects over half of all women during their adult life.

Vaginal bleeding is any bleeding from the vagina. This bleeding may originate from the uterus, vaginal wall, or cervix. Generally, it is either part of a normal menstrual cycle or is caused by hormonal or other problems of the reproductive system, such as abnormal uterine bleeding.

Fetal fibronectin (fFN) is a fibronectin protein produced by fetal cells. It is found at the interface of the chorion and the decidua.

Vaginal atresia is a condition in which the vagina is abnormally closed or absent. The main causes can either be complete vaginal hypoplasia, or a vaginal obstruction, often caused by an imperforate hymen or, less commonly, a transverse vaginal septum. It results in uterovaginal outflow tract obstruction. This condition does not usually occur by itself within an individual, but coupled with other developmental disorders within the female. The disorders that are usually coupled with a female who has vaginal atresia are Rokitansky-Mayer- Küster-Hauser syndrome, Bardet-Biedl syndrome, or Fraser syndrome. One out of every 5,000 women have this abnormality.

Salpingitis infection and inflammation in the fallopian tubes

Salpingitis is an infection and inflammation in the Fallopian tubes (salpinges). It is often used synonymously with pelvic inflammatory disease (PID), although PID lacks an accurate definition and can refer to several diseases of the female upper genital tract, such as endometritis, oophoritis, myometritis, parametritis and infection in the pelvic peritoneum. In contrast, salpingitis only refers to infection and inflammation in the fallopian tubes.

This is a shortened version of the fourteenth chapter of the ICD-10: Diseases of the genitourinary system. It covers ICD codes N00.0 to N99.9. All versions of the ICD-10, including the most recent one (2019), can be browsed freely on the website of the World Health Organisation (WHO). The ICD-10 can also be downloaded in PDF-form.

Pelvic examination physical examination of the external and internal female pelvic organs

A pelvic examination is the physical examination of the external and internal female pelvic organs. It is frequently used in gynecology for the evaluation of symptoms affecting the female reproductive and urinary tract, such as pain, bleeding, discharge, urinary incontinence, or trauma. It can also be used assess a patient's anatomy in preparation for procedures. The exam can be done awake in the clinic and emergency department, or under anesthesia in the operating room. The most commonly performed components of the exam are 1) the external exam, to evaluate the external genitalia 2) the internal exam with palpation to examine the uterus, ovaries, and fallopian tubes, and 3) the internal exam using the speculum to visualize the vaginal walls and cervix. During the pelvic exam, sample of cells and fluids may be collected to screen for sexually transmitted infections or cancer.

Endometrial biopsy

The endometrial biopsy is a medical procedure that involves taking a tissue sample of the lining of the uterus. The tissue subsequently undergoes a histologic evaluation which aids the physician in forming a diagnosis.

Hematometra Human disease

Hematometra is a medical condition involving collection or retention of blood in the uterus. It is most commonly caused by an imperforate hymen or a transverse vaginal septum.

Breast cancer screening

Breast cancer screening is the medical screening of asymptomatic, apparently healthy women for breast cancer in an attempt to achieve an earlier diagnosis. The assumption is that early detection will improve outcomes. A number of screening tests have been employed, including clinical and self breast exams, mammography, genetic screening, ultrasound, and magnetic resonance imaging.

Neuroendocrine carcinoma of the cervix is best defined separately:Neuroendocrine: Of, relating to, or involving the interaction between the nervous system and the hormones of the endocrine glands.Carcinoma: An invasive malignant tumor derived from epithelial tissue that tends to metastasize to other areas of the body.

Postcoital bleeding is bleeding from the vagina in women after sexual intercourse and may or may not be associated with pain. The bleeding can be from the uterus, cervix, vagina and other tissue or organs located near the vagina. Postcoital bleeding can be one of the first indications of cervical cancer. There are other reasons why a woman may bleed after intercourse. Some women will bleed after intercourse for the first time but others will not. The hymen may bleed if it is stretched since it is thin tissue. Other activities may have an effect on the vagina such as sports and tampon use. Postcoital bleeding may stop without treatment. In some instances, postcoital bleeding may resemble menstrual irregularities. Postcoital bleeding may occur throughout pregnancy. The presence of cervical polyps may result in postcoital bleeding during pregnancy because the tissue of the polyps is more easily damaged. Postcoital bleeding can be due to trauma after consensual and non-consensual sexual intercourse.

A rectovaginal examination is a type of gynecological examination used to supplement a pelvic examination. In the rectovaginal examination, a doctor or other health care provider places one finger in the vagina and another in the rectum to assess the rectovaginal septum. The examiner will look for any scarring or masses that may indicate cancer or another disease. Typically, a rectovaginal examination is performed to assess pelvic pain, rectal symptoms, or a pelvic mass. It can also provide a sample for fecal occult blood testing.

Breast imaging new QT Breast Imaging FDA approved

In medicine, breast imaging is a sub-speciality of diagnostic radiology that involves imaging of the breasts for screening or diagnostic purposes. There are various methods of breast imaging using a variety of technologies as described in detail below. Traditional screening and diagnostic mammography uses x-ray technology. Breast tomosynthesis is a new digital mammography technique that produces 3D images of the breast using x-rays. Xeromammography and Galactography also use x-ray technology and are also used infrequently in the detection of breast cancer. Breast ultrasound is another technology employed in diagnosis & screening and specifically can help differentiate between fluid filled and solid lumps that can help determine if cancerous. Breast MRI is, yet, another technology reserved for high-risk patients and can help determine the extent of cancer if diagnosed. Lastly, scintimammography is used in a subgroup of patients who have abnormal mammograms or whose screening is not reliable on the basis of using traditional mammography or ultrasound.

References

  1. Kath Evans (July 2003). "INTIMATE EXAMINATION, PROCEDURE, CARE & CHAPERONING POLICY" (PDF). Whittington Hospital NHS Trust.Cite journal requires |journal= (help)
  2. Helen Barratt (October 2001). "School pupil allowed to observe intimate examination". Student BMJ. BMJ Publishing Group Ltd. 09: 357–398.
  3. "ACOG Committee Opinion No. 755 Summary: Well-Woman Visit". Obstetrics & Gynecology. 132 (4): 1084–1085. October 2018. doi:10.1097/AOG.0000000000002898. ISSN   0029-7844.
  4. "Reproductive Health Information - The Well Woman Exam". Baylor College of Medicine. Center for research on women with disabilities. Retrieved 2013-04-17.
  5. "Well Woman's Exam". trive. Campus Health Services. Retrieved 2013-04-17.
  6. 1 2 3 4 "Examen de las Mamas". Manual de Semiología. Retrieved 2013-04-19.
  7. "Manual de exploración Física de las Mamas" (PDF). Secretaría de Salud. Retrieved 2013-04-19.
  8. "Practice Bulletin Number 179: Breast Cancer Risk Assessment and Screening in Average-Risk Women". Obstetrics & Gynecology. 130 (1): e1–e16. July 2017. doi:10.1097/AOG.0000000000002158. ISSN   0029-7844.
  9. "Mammography". Medline Plus. U.S. Department of Health and Human Services National Institutes of Health. Retrieved 2013-04-22.
  10. "Ultrasonido mamario". FUCAM. Retrieved 2013-04-22.
  11. 1 2 Parrondo P, Pérez-Medina T, Álvarez-Heros J (April 2013). "Anatomía del aparato genital femenino" (PDF). Salud Mujer: 15–18.
  12. 1 2 "Examen ginecológico". Manual de Semiología. Retrieved 2013-04-19.
  13. "Pelvic Exam". Stanford Medicine 25. Retrieved 2020-03-31.
  14. 1 2 "UCSD's Practical Guide to Clinical Medicine". meded.ucsd.edu. Retrieved 2020-03-31.
  15. 1 2 "Técnica de colocación del eséculo". Omar Morera. Retrieved 2013-04-18.
  16. Cavanaugh, Robert M. (2007-09-01). "Screening Adolescent Gynecology in the Pediatrician's Office: Have a Listen, Take a Look". Pediatrics in Review. 28 (9): 332–342. doi:10.1542/pir.28-9-332. ISSN   0191-9601. PMID   17766592.
  17. "Screening Guidelines - ASCCP". www.asccp.org. Retrieved 2020-04-01.
  18. Klein S., Miller S., Thomson F002E (May 2000). "El examen pélvico" (PDF). Atención del embarazo, el parto y la salud de la mujer: 373–387.CS1 maint: multiple names: authors list (link)
  19. "Recommendations for Women's Healthcare Coverage | Women's Preventive Services Initiative". www.womenspreventivehealth.org. 2018-10-01. Retrieved 2020-04-01.