Reference Manual - IARC Screening Group

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Performing Breast and Pelvic Examinations• As you advance the speculum, gently rotate the blades into ahorizontal position with the handle down (Figure G-16). Be surethe labia do not fold inward while advancing the speculum. Insertit fully or until resistance is felt.Figure G-16. Rotating the Speculum• Gently open the blades (Figure G-17) until the cervix comes intofull view (Figure G-18); then fix the blades in the open positionby tightening the upper thumbscrew.If you are having difficulty locating the cervix, withdraw the speculumslightly, move the speculum so that it points more posteriorly and gentlyadvance the speculum again. Open the blades slowly to see if the cervixhas come into view.Figure G-17. Opening the Speculum BladesG-22 Cervical Cancer Prevention Guidelines for Low-Resource Settings
Figure G-18. Speculum in Place with Blades OpenPerforming Breast and Pelvic Examinations• Look at the vaginal walls:• The mucosa should be pink in color with a moist and smooth orfolded (rugae) surface. Note any inflammation, ulcers or sores.Normal secretions are usually thin, clear or cloudy, and odorless.• Look for any abnormal vaginal discharge: watery, bubbly, foul or“fishy” smelling, “cheesy” white or gray. Take a sample of anyvaginal discharge for pH, saline or KOH wet mounts and, ifpossible, for a Gram’s stain (if laboratory facilities available).• Look at the cervix and cervical opening (os):• The cervical os of a nulliparous woman is small and round oroval. The os of a parous woman is usually a horizontal slit, butmay be irregular and open.• Note the color of the cervix. The surface should be smooth andpink, with the color evenly distributed. The area of the cervixwhere the color changes from pink to red is the T-zone, which isusually just inside the external cervical os.• Note the position of the cervix (anterior or posterior); if there arepolyps, nodules, cysts or any erosion or shiny red tissue aroundthe os (ectropion); or if there is bleeding or discharge containingpus. Normal cervical secretions should be clear or cream-coloredand odorless.• The cervix should not bleed easily when gently touched with acotton-tipped swab.• If there is mucopus or if the cervix bleeds easily, a specimenshould be obtained for Gram’s stain and tests for gonorrhea andchlamydia (if laboratory facilities are available).• After obtaining any specimens, unlock the speculum blades bykeeping your thumb on the lever and loosening the thumbscrew(s).While keeping the blades partly separated, rotate the speculum 90°.Cervical Cancer Prevention Guidelines for Low-Resource Settings G-23
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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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Infection Prevention Processesfor m
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Page 139 and 140: APPENDIX DTECHNICAL OVERVIEW OF THE
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Page 149 and 150: APPENDIX ETROUBLESHOOTING WITH THEC
Page 151 and 152: Table E-1. Following-Up on Commonly
Page 153 and 154: APPENDIX FPROCESSING SURGICAL GLOVE
Page 155 and 156: Processing Surgical GlovesTable F-1
Page 157 and 158: Processing Surgical GlovesSTEP 10:
Page 159 and 160: APPENDIX GPERFORMING BREAST AND PEL
Page 161 and 162: Performing Breast and Pelvic Examin
Page 163 and 164: Figure G-2. Breast Puckering or Dim
Page 165 and 166: Figure G-5. Checking for Nipple Dis
Page 179: Performing Breast and Pelvic Examin
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
Page 216: innovating to save liveswww.jhpiego
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Reference Manual - IARC Screening Group

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