Reference Manual - IARC Screening Group

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Performing Breast and Pelvic ExaminationsLEARNING GUIDE FOR PELVIC EXAMINATIONSSTEP/TASK3. Turn on light and direct it toward genital area.4. Put new examination or high-level disinfected gloves on both hands.5. Touch the inside of her thigh before touching any of the genital area.6. Inspect the labia, clitoris and perineum.7. Separating the labia majora with two fingers, check the labia minora, clitoris,urethral opening and vaginal opening.8. Palpate the labia minora. Look for swelling, discharge, tenderness, ulcers andfistulas. Feel for any irregularities or nodules.9. Check the Skene’s glands for discharge and tenderness. With the palm facingupward, insert the index finger into the vagina and gently push upward againstthe urethra and milk the gland on each side and then directly on the urethra. (Ifdischarge is present, take a smear for Gram’s stain and tests for gonorrhea andchlamydia, if laboratory facilities are available.)10. Check the Bartholin’s glands for discharge and tenderness. Insert index fingerinto vagina at lower edge of opening and feel at base of each of the labiamajora. Using your finger and thumb, palpate each side for any swelling ortenderness. (If discharge is present, take a smear for Gram’s stain and tests forgonorrhea and chlamydia, if laboratory facilities are available.)11. Ask the woman to bear down while you hold the labia open. Check for anybulging of the anterior or posterior vaginal walls.12. Look at the perineum. Check for any scarring, lesions, inflammation or cracksin the skin.SPECULUM EXAMINATION1. Select a bivalve speculum and show it to the woman. Explain what you aregoing to do.2. Insert the speculum fully and open the blades. Look at the vaginal walls andnote any inflammation, ulcers or sores. Check for any discharge.3. Look at the cervix and os and note the color, position, smoothness ordischarge. If the cervix bleeds easily or there is mucopus, obtain a specimenfor Gram’s stain and tests for gonorrhea and chlamydia, if laboratory facilitiesare available.4. Remove the speculum.5. Place the speculum in 0.5% chlorine solution for decontamination.BIMANUAL EXAMINATION1. Wet the index and middle fingers of the hand that will be inserted in the vagina(pelvic hand) with clean water or vaginal secretions.2. Separate the labia with two finger of the abdominal hand and insert the tips ofthe index and middle fingers of the pelvic hand into the vagina.3. While exerting pressure downward, wait for the perineal muscles to relax.Gradually insert fingers fully or until the cervix is touched.4. Turn your palm upward and follow the anterior vaginal mucosa until you feelthe cervix.5. Feel the length, size and shape of the cervix. Note its position and consistency.6. Move the cervix gently from side to side between your fingers. Note whetherthe woman feels pain.CASESG-40 Cervical Cancer Prevention Guidelines for Low-Resource Settings
Performing Breast and Pelvic ExaminationsLEARNING GUIDE FOR PELVIC EXAMINATIONSSTEP/TASK7. With the palm up, place the fingers of your pelvic hand in the space behind thecervix to feel the body of the uterus.8. Place your other hand flat on the abdomen, midway between the umbilicus andthe pubic bone.9. Slowly slide your abdominal hand toward the symphysis pubis, pressingdownward and forward with the pads of your fingers. At the same time, pushinward and upward with the fingers of the pelvic hand, trying to trap the uterusbetween your hands. If you cannot feel the uterus, check whether it isretroverted.10. Palpate the uterus and check for:• Size• Shape• Location• Consistency• Mobility• Tenderness11. Locate an ovary by placing the fingers of the pelvic hand inside the vaginawith the tips in the lateral fornix. Move your abdominal hand to the same sideand lateral to the uterus. Press down with the abdominal hand and reach upwith the fingers of your pelvic hand. Gently bring the fingers of both handstogether and move them toward the symphysis pubis.12. Determine size, consistency and mobility of ovary.13. Repeat this procedure for the other ovary.14. Check the size, shape consistency, mobility and tenderness of any masses inthe adnexa.RECTOVAGINAL EXAMINATION1. Explain to the woman what you are going to do.2. If you need to change your gloves, immerse both hands in 0.5% chlorinesolution, then remove them by turning them inside out. If disposing of them,place them in a leakproof container or plastic bag. If reusing the gloves,submerge then in 0.5% chlorine solution for decontamination.3. Slowly insert the middle finger of the pelvic into the rectum and your indexfinger into the vagina. Ask the woman to exhale to help her relax.4. Press down firmly and deeply with the abdominal hand above the pubic bonewhile the vaginal and rectal fingers are pushing anteriorly on the cervix.5. Feel the surface of the uterus and check to see if it is smooth.6. Check for tenderness or masses between the uterus and rectum.7. After you have completed the examination, remove both fingers slowly.8. Immerse both gloved hands in 0.5% chlorine solution, remove gloves byturning inside out and dispose of them in a leakproof container or plastic bag.COMPLETING THE PELVIC EXAMINATION1. If rectovaginal examination was not performed, immerse both gloved hands n0.5% chlorine solution, then remove gloves by turning them inside out.• If disposing of gloves, place them in a leakproof container.• If reusing the gloves, submerge them in 0.5% chlorine solution fordecontamination.CASESCervical Cancer Prevention Guidelines for Low-Resource Settings G-41
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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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Infection Prevention Processeswith
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Infection Prevention ProcessesFigur
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Table C-4. Preparing and Using Chem
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Infection Prevention ProcessesStora
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Infection Prevention Processes• h
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APPENDIX DTECHNICAL OVERVIEW OF THE
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Technical Overview of the Cryothera
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Figure D-5. Removing Protector Tube
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Technical Overview of the Cryothera
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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
Page 163 and 164: Figure G-2. Breast Puckering or Dim
Page 165 and 166: Figure G-5. Checking for Nipple Dis
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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
Page 216: innovating to save liveswww.jhpiego
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