Reference Manual - IARC Screening Group

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Performing Breast and Pelvic ExaminationsFigure G-14. Checking the Bartholin’s Glands• Ask the woman to bear down while you hold the labia open andwatch for any bulging of the anterior or posterior vaginal walls.(Bulging of the anterior vaginal wall indicates cystocele; bulging ofthe posterior wall is due to a rectocele. If the cervix pushes outthrough the vaginal opening, this is a uterine prolapse.)• Look at the perineum.• The surface should be thick and smooth in a nulliparous woman;it will be thinner and rigid in a multiparous woman.• The anal skin is more darkly pigmented, and may look coarse.There should not be any scarring, lesions, inflammation, lumps,stretch marks, cracks or tears in the skin.If there are open sores in this area, change gloves before doing thespeculum and bimanual examinations. Doing this will avoid introducingfecal microorganisms, especially E. coli, into the vagina.These gloves cannot be reused. Immerse both gloved hands in 0.5%chlorine solution, remove the gloves by turning them inside out and placein a leakproof container or plastic bag. Then, wash and dry your handsbefore putting on another pair of gloves.SPECULUM EXAMINATIONIn this section, you will learn:• How to look for vaginal or cervical discharge, tears, ulcers or otherabnormalities such as cervical lesions (cervicitis or cervical cancer)• How to take specimens for diagnostic studies (if appropriate andavailable)G-20 Cervical Cancer Prevention Guidelines for Low-Resource Settings
Performing Breast and Pelvic Examinations• How to check for any condition(s) that may require management(e.g., absence of IUD strings) or to evaluate results of treatment (e.g.,antibiotics for cervicitis)Preparation • Once the woman is prepared for the external genitalia examination,no further preparation is necessary.• If it was necessary to dispose of your gloves following the externalgenitalia examination, wash your hands with soap and water and drywith a clean cloth or allow to air dry. Put a new pair of examinationor high-level disinfected surgical gloves on both hands.Performing aSpeculumExamination• Select the smallest bivalve speculum that will allow you to see thevagina and cervix adequately.• Before inserting the speculum, show it to the woman and explain thatyou are going to insert part of it into her vagina.• When inserting the speculum, ask the woman to breathe in deeply andthen breathe out slowly through her mouth. This will help her to relaxand not contract her vaginal muscles.• To insert the speculum:• Gently insert the index finger of one hand just inside the vaginalopening and push down firmly on the perineum towards therectum. (This relaxes the vaginal muscles and makes it easier toinsert the speculum.) If the vagina is dry, lubricate the blades ofthe speculum with water before insertion.• With your other hand, hold the closed speculum so that the closedblades are in a vertical plane and at a slightly oblique angle(Figure G-15a).• As you gently insert the speculum into the vagina in a posteriordirection, remove your index finger (Figure G-15b). Doing thisavoids pressure on the urethra, which is painful.Be careful not to pull on the pubic hair or pinch the labia with thespeculum.Figure G-15a and b. Inserting the SpeculumCervical Cancer Prevention Guidelines for Low-Resource Settings G-21
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Cervical Cancer PreventionGuideline
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TABLE OF CONTENTSPREFACE AND ACKNOW
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How to High-Level Disinfect Surgica
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Table C-2Figure C-1Preparing a Dilu
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PREFACE AND ACKNOWLEDGMENTSThis ref
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ONEINTRODUCTIONMAGNITUDE OF THE PRO
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IntroductionFigure 1-3. Incidence o
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Introductionprevalence areas, a sta
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Table 1-2. Reduction in Cumulative
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Introductiontheir performance was t
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Introductionlesions, or a false pos
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IntroductionCompared to other metho
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Introductionsignificantly to women
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IntroductionBelinson JL et al. 2001
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IntroductionMitchell MF et al. 1998
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IntroductionYlitalo N et al. 1999.
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TWOHUMAN PAPILLOMAVIRUS AND CERVICA
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Human Papillomavirus and Cervical C
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THREEPATHOPHYSIOLOGY OF CERVICAL CA
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With the onset of puberty, whichis
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Pathophysiology of Cervical Cancerp
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Pathophysiology of Cervical CancerP
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Pathophysiology of Cervical CancerI
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Pathophysiology of Cervical CancerR
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FOURTALKING WITH WOMEN ABOUTCERVICA
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Talking with Women About Cervical C
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FIVEPREVENTING INFECTIONS INHEALTHC
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Preventing Infections in Healthcare
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SIXCLIENT ASSESSMENT AND VIA TESTIN
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Client Assessment and VIA TestingFi
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Client Assessment and VIA TestingIN
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Client Assessment and VIA Testingst
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Client Assessment and VIA Testingsp
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Client Assessment and VIA Testingth
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SEVENTREATMENT AND FOLLOWUPBACKGROU
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Treatment and Followupregardless of
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Treatment and FollowupFigure 7-1. L
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Treatment and FollowupTable 7-6. Co
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Treatment and FollowupFigure 7-2 is
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Treatment and Followup• Regulator
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Treatment and FollowupCRYOTHERAPY P
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Treatment and FollowupStep 6 Point
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Treatment and FollowupNote: When CO
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Treatment and FollowupStep 5Advise
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Treatment and FollowupBerget A, B A
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APPENDIX ATESTS FOR CERVICAL CANCER
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Tests for Cervical Cancer Screening
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APPENDIX BSCREENING TEST QUALITIES
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Screening Test Qualities and Their
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APPENDIX CINFECTION PREVENTION PROC
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Page 149 and 150: APPENDIX ETROUBLESHOOTING WITH THEC
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Page 153 and 154: APPENDIX FPROCESSING SURGICAL GLOVE
Page 155 and 156: Processing Surgical GlovesTable F-1
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Page 159 and 160: APPENDIX GPERFORMING BREAST AND PEL
Page 161 and 162: Performing Breast and Pelvic Examin
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Page 205 and 206: APPENDIX HPERCEIVED BARRIERS TO PRO
Page 207 and 208: AVAILABILITY OF BASIC SUPPLIES AND
Page 209 and 210: GLOSSARYAcetic AcidAcetowhite Chang
Page 211 and 212: PatulousSquamocolumnarJunction (SCJ
Page 213 and 214: ADDITIONAL READINGAlliance for Cerv
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Reference Manual - IARC Screening Group

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