Reference Manual - IARC Screening Group

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