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Endometriosis: Clinical Manifestation and Differential Diagnosis
Published in Nazar N. Amso, Saikat Banerjee, Endometriosis, 2022
Doing rectovaginal examination on 140 cases under anesthesia before proceeding to laparoscopy or laparotomy, where the indication was masked, it was shown that rectovaginal examination has marked limitations despite the controlled circumstances of the operating room including general anesthesia, an empty bladder and ideal patient positioning. The specificity of the rectal examination is high, but the sensitivity of the rectovaginal examination is low (58).
Fistula repair
Published in J. Richard Smith, Giuseppe Del Priore, Robert L. Coleman, John M. Monaghan, An Atlas of Gynecologic Oncology, 2018
Careful examination, if necessary under anesthesia, may be required to determine the presence of a fistula, and is deemed by several authorities to be essential for definitive surgical treatment. It is important at the time of examination to assess the available access for repair vaginally, and the mobility of the tissues. The decision between the vaginal and abdominal approaches to surgery is thus made; when the vaginal route is chosen, it may be appropriate to select between the more conventional supine lithotomy, with a head-down tilt, and the prone (reverse) lithotomy position with head-up tilt. This may be particularly useful in allowing the operator to look down onto bladder neck and subsymphysial fistulas, and is also of advantage in some massive fistulas in encouraging the reduction of the prolapsed bladder mucosa. A rectovaginal examination may detect a rectovaginal fistula; probing of a perineal sinus with a fine metallic catheter may identify an anoperineal tract.
Gynaecological history, examination and investigations
Published in Helen Bickerstaff, Louise C Kenny, Gynaecology, 2017
In some situations, a rectal examination with specific additional consent can be useful in addition to a vaginal examination to differentiate between an enterocele and a rectocele or to palpate the uterosacral ligaments more thoroughly. Occasionally, a rectovaginal examination (index finger in the vagina and middle finger in the rectum) may be useful to identify a lesion in the rectovaginal septum.
Sexual well-being after menopause: An International Menopause Society White Paper
Published in Climacteric, 2018
J. A. Simon, S. R. Davis, S. E. Althof, P. Chedraui, A. H. Clayton, S. A. Kingsberg, R. E. Nappi, S. J. Parish, W. Wolfman
The gentle introduction of the speculum with the patient’s permission confirms the normalcy of the cervix, presence of inflammation, or lesions. The physical findings and history will direct cervical smear tests or cultures for yeast, bacterial vaginosis or sexually transmitted infections. Rotation of the speculum by 90° and separation of the blades to view the anterior and posterior vaginal walls are indicated if pelvic floor relaxation is suspected. Bimanual examination to rule out tenderness of the bladder, vaginal walls, cervix, uterus or adnexa or any additional uterine or adnexal enlargement usually completes the examination6. In the presence of deep pelvic pain, rectovaginal examination may be useful for rectovaginal nodules found in endometriosis or cul-de-sac pathology.
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
Subjects for comparison were chosen among consecutive patients admitted to two gynecological outpatient clinics for their annual gynecological examinations according to the inclusion criteria. They were primarily evaluated by taking a complete history that included urinary, gastrointestinal, gynecologic, and musculoskeletal systems and sexual functions in the examination room. The pelvic examination was typically performed in the lithotomy position that included the visual inspection of the genitalia, the palpation of the introitus and vagina, and the speculum examination of the vagina and cervix. Transvaginal ultrasonography was performed. External genitalia and vagina were evaluated for lesions, abrasions, ulceration, erythema, edema, and discharge. A cotton swab was used for point-pressure testing if a patient had dyspareunia or vulvar pain. Pelvic floor muscles, urethra, bladder, cervix, vaginal fornices, uterine size and mobility, and bilateral adnexal regions were assessed by digital vaginal examination. Furthermore, the tenderness and nodularity of the rectovaginal septum and uterosacral ligaments were assessed by the rectovaginal examination. If the subjects had dyspareunia or vulvar pain on pelvic examination or had a history of dyspareunia or vulvodynia, they were excluded from the study. Those who did not report any complaints were informed about the present study and referred to the sexual dysfunction outpatient clinic. Thereafter, the subjects were evaluated by the psychologist whether they had any severe psychiatric disorder (mental retardation and psychotic disorder) that might interfere with the assessment. Those who had no severe psychiatric disorder and volunteered to participate in the study completed the related forms in the sexual dysfunction outpatient clinic in a single session.
Analysis of the prognostic factors determining the oncological outcomes in patients with high-risk early-stage cervical cancer
Published in Journal of Obstetrics and Gynaecology, 2022
Fatih Kilic, Caner Cakir, Dilek Yuksel, Vakkas Korkmaz, Gunsu Kimyon Comert, Nurettin Boran, Sevgi Koc, Taner Turan, Osman Turkmen
The patients were initially evaluated by abdominal and pelvic computed tomography (CT), MRI, or Positron Emission Tomography-Computed Tomography (PET/CT) examinations. Physical examination was performed under general anaesthesia, and the patients were clinically staged according to the FIGO 2009 staging system. In rare cases, an intravenous pyelogram was used. Tumour size was the greatest tumour diameter determined by rectovaginal examination under general anaesthesia. Furthermore, the tumour size was stratified based on the FIGO 2018 criteria as follows: <2 cm, ≥2 cm–<4 cm, and ≥4 cm.