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Uterine Cavity Assessment (Saline Hysterosonography)
Published in Arianna D'Angelo, Nazar N. Amso, Ultrasound in Assisted Reproduction and Early Pregnancy, 2020
The procedure is easier to perform after the patient has emptied her bladder. This results in better visualization of the uterus and is also more comfortable for the patient, who is placed into the lithotomy position on a gynecological examination chair or couch. A routine gynecological examination is performed to rule out infections or suspicious lesions. If purulent vaginal or cervical discharge, unusual pain, and lesions are observed, further investigation may be required before the procedure can be carried out. After the gynecological examination, detailed transvaginal ultrasound scan is performed in order to detect any abnormality in cervix, uterus, adnexa, and pelvic cavity. Since the focus of saline hysterosonography is the evaluation of the uterus and uterine cavity, the position and size of the uterus should be noted. The uterus is scanned in longitudinal and transverse section. Endometrial thickness is measured, and its sonographic appearance recorded. Pregnancy signs or signs of ovulation are also ruled out. In the pelvis, the amount of free fluid before the start of hysterosonography is also measured.
Sexuality and Sexual Dysfunction
Published in Jane M. Ussher, Joan C. Chrisler, Janette Perz, Routledge International Handbook of Women’s Sexual and Reproductive Health, 2019
Allowing patients to discuss sexual matters, validating and normalizing their concerns, and offering specific suggestions (e.g., to encourage acceptance of normal changes in desire and arousal or to discuss the issue with a partner) can alleviate sexuality-related distress and improve sexual functioning (Annon, 1976). A referral to a sexual health expert is recommended whenever a sexual concern is perceived as severe, long-lasting, and distressing and does not sufficiently respond to these interventions. A thorough gynecological examination is important to identify medical factors that could contribute to a sexual difficulty, and a psychological evaluation of the problem (including predisposing, triggering, and maintaining factors) is necessary to distinguish clinically relevant sexual dysfunctions from short-term, low distress, or sub-clinical sexual problems. As part of this diagnostic process, clinicians trained in sexual health should conduct a comprehensive interview inquiring about all aspects of the sexual response cycle, namely desire, excitement, and orgasm (Kaplan, 1977; Masters & Johnson, 1966) to identify those phases of the sexual response that are perceived as problematic.
The Reproductive System and Its Disorders
Published in Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss, Understanding Medical Terms, 2020
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss
The pelvic examination is an essential part of routine annual gynecological examination and begins with a visual inspection of the external genitalia and, after insertion of the speculum, of the cervix and vaginal wall. During the exam, a cervical smear is taken for the Papanicolaou test (Pap test) to detect abnormal cells indicative of cervical cancer. Pap smear reports are grouped into four categories. A Class I result indicates no abnormal cells; Class II contains atypical cells that are usually caused by inflammation; cells suspicious of carcinoma are found in Class III; and carcinoma cells are present in Classes IV and V. Any suspicious lesion is generally biopsied, and a cervical punch biopsy and endocervical curettage are used to diagnose invasion. Cold knife conebiopsy can confirm the diagnosis and remove the lesion, which is sometimes sufficient treatment. Biopsy is also the primary diagnostic procedure for most other malignancies, although laparoseopy (insertion of and examination with a laparoscope) is needed for examination and biopsy of some organs.
The Role of Anxiety and Childhood Trauma on Vaginismus and Its Comorbidity with Other Female Sexual Dysfunctions
Published in International Journal of Sexual Health, 2020
Sinan Tetik, Eylem Unlubilgin, Fulya Kayikcioglu, Nurhan Bolat Meric, Nurettin Boran, Ozlem Moraloglu Tekin
The sample of the study consisted of 50 patients diagnosed with primary vaginismus who applied to the sexual dysfunction outpatient clinic of a gynecology training and research hospital in Ankara, the capital city of Turkey, and 50 subjects for comparison who were admitted to the same hospital between October 2018 and May 2019. The patient group who participated in the study was examined by a female gynecologist in the sexual dysfunction outpatient clinic. Pelvic examination of the patient group included assessment of the external appearance of the vulva, vulvar sensitivity (using a cotton swab to exert light pressure on the vulva and labium), and anatomy of the hymenal ring. The majority of the patient group had difficulty having the gynecological examination. Only three out of 50 patients could have a pelvic examination in the first session. The presence of an involuntary contraction of some or all of the pelvic floor muscles was noted by the gynecologist. Rejection of pelvic examination or distress displayed by the patient during the pelvic examination were also noted. Patients who had no gynecological complaint were referred to the psychologist. After the clinical interview with the psychologist, volunteers among the participants who were diagnosed with primary vaginismus according to the DSM-4-TR diagnostic criteria were included in the study. In the sexual history taken from all the patients, no sexual problems that meet the diagnosis of another primary and independent sexual dysfunction were detected.
Do women with pelvic floor disorders prefer to be treated by female urogynecologists?
Published in Health Care for Women International, 2020
Asnat Groutz, David Gordon, Mordechai Shimonov, Hadar Amir
Intimate medical examinations may be interpreted as embarrassing. This embarrassment is might be due to perceptions of gender roles, norms, and stereotypes. Masculinity and femininity are not perceived equally (Koenig, 2018). Women are generally perceived as more gentle, polite, accommodating, and tolerant, whereas men are perceived as more aggressive and intolerant. Some female patients may therefore feel more comfortable with same gender health care provider, especially in intimate medical situations. Patients who feel uncomfortable with intimate medical examinations might discontinue or avoid further medical investigations. As a result, there may be a delay in medical diagnosis, or irreversible damage. Therefore, several groups of well-known gynecological organizations have published guidelines on how to perform a gynecological examination, such as adequate coverage, the presence of a third party during the medical examination, and a detailed explanation to the patient (ACOG Committee Opinion No, 587, 2014; SOGC Guidelines No. 266, 2017).
Medical students and intimate examinations: What affects whether a woman will consent?
Published in Medical Teacher, 2018
Alexander J. Armitage, David J. Cahill
These factors include the student being female, the student being older (both immutable factors), being relaxed in manner and smartly dressed, and engaging in history taking with the patient prior to making the request. Female students have been described elsewhere as being more likely to have access to intimate vaginal examinations (O’Flynn and Rymer 2002; Racz et al. 2008) while older students are more likely to be acceptable for any sort of examination, excluding genital examination (Koehler and McMenamin 2012). The last finding (the impact of engaging in history taking with the patient) which has not been shown elsewhere, supports our approach: medical students are encouraged to gain experience in vaginal examination in the clinic setting, though this is pragmatic rather than intentional. In our department, students are given time to take a history and develop a rapport with the patient before conducting a supervised gynecological examination. Our findings add weight to the value of this “history first” method brings benefits over other methods of teaching vaginal examination (gynecology teaching associates and dedicated teaching clinics), in that it exposes the student more acutely to the professional challenges associated with performing intimate examination. The apparent contradiction of being relaxed and smartly dressed is probably related to these factors portraying professionalism.