Introduction to Clinical Skills

Pelvic, Genitalia and Groin Exam

Universidad Iberoamericana UNIBE

Introduction to Clinical Skills

Teaching Staff Dra Elizabeth Peralta Dr Marcos Núñez Dra Cristina Páez C Dr Juan Carlos Mariñez Dra Wayna Greo Dra Yun Pey Lee

Introduction to Clinical Skills

Pelvic Examination Sacrococcigeal area Perineum Rectum

Inspection External Internal (anoscopy)

Palpation RDE

Introduction to Clinical Skills

Pelvic Examination Sacrococcigeal area

Inspection Palpation

Introduction to Clinical Skills

Pelvic Examination Perineum

Inspection Palpation

Introduction to Clinical Skills

Pelvic Examination The Rectum. The Health History

Change in bowel habits Blood in the stools Pain with defecation, rectal bleeding or tenderness Anal warts or fissures Weak stream of urine Burning with urination

Introduction to Clinical Skills

Pelvic Examination The Rectum. Health Promotion and Counseling

Screening for prostate cancer Screening for polyps and colorectal cancer Counseling for sexually transmitted diseases

Introduction to Clinical Skills

Pelvic Examination The Rectum. Techniques for examination

Sims position Lithotomy position Jacknife position

Introduction to Clinical Skills

Pelvic Examination Rectum

Inspection External Internal (anoscopy)

Palpation RDE

Male Female

Introduction to Clinical Skills

Pelvic Examination Rectum. Recording your findings:

“No perirectal lesions or fissures. External sphincter tone intact. Rectal vault without masses.Prostate smooth and non tender with palpable median sulcus.(or in female, uterine cervix non tender.) Stool brown and hemoccult negative”

Introduction to Clinical Skills

Introduction to Clinical Skills

Genitalia Exam Embriology Male

External Internal

Female External Internal

Introduction to Clinical Skills

Male Genitalia

Introduction to Clinical Skills

Male Genitalia Common or concerning Symptoms

Sexual preference Penile discharge or lesions Scrotal pain, swelling or lesions

Introduction to Clinical Skills

Male Genitalia Tips for taking the Sexual History

Explain why you are taking the sexual history Note that you realice this information is highly personal,and

encourage the patient to be open and direct Relate that you gather this history on all your patients Affirm that your conversation is confidential

Introduction to Clinical Skills

Male Genitalia Health Promotion and Counseling

Prevention of STD´s and HIV Testicular self examination

Introduction to Clinical Skills

Male Genitalia Physical Exam requirements

Privacy (drapes) Chaperone Gloves Culturette

Introduction to Clinical Skills

Male Genitalia Physical Exam techniques Secondary Male development

Penis Shape Gland Prepuce

Scrotum Testicles

Shape Epididimus Vas deferens

Prostate (RDE)

Introduction to Clinical Skills

Male Genitalia. Recording your findings “Circumcized male. No penile discharge or lesions. No scrotal

swelling or discoloration.Tested descended bilaterally, smooth, without masses. Epididymis nontender. No inguinal or femoral hernias.”

Introduction to Clinical Skills

Female Genitalia

Introduction to Clinical Skills

Female Genitalia. The Health History Menarche, menstruation, menopause, postmenopausal bleeding Pregnancy Vulvovaginal symptoms Sexual preference and sexual response

Introduction to Clinical Skills

Female Genitalia. The Menstrual History: definitions Menarche Menopause Postmenopausal bleeding Amenorrhea Dysmenorrhea Premenstrual syndrome Abnormal uterine bleeding

Introduction to Clinical Skills

Female Genitalia. Health Promotion and Counseling Cervical cancer screening. Pap smear and HPV infection Options for family planning Sexually transmitted diseases and HIV Changes in menopause

Introduction to Clinical Skills

Female Genitalia Physical Exam requirements

Privacy (drapes) Chaperone Gloves Culturette

Introduction to Clinical Skills

External Examination Mons pubis Labia majora and minora Urethral meatus, clitoris Vaginal introitus Perineum

Internal Examination Vagina, vaginal walls Cervix Uterus, ovaries Pelvic muscles Rectovaginal wall

Introduction to Clinical Skills

Female Genitalia Physical Exam techniques Secondary Female development

External genitalia Internal genitalia

Introduction to Clinical Skills

Female Genitalia. Recording your findings “No inguinal adenopathy. External genitalia without erythema,

lesions or masses. Vaginal mucosa pink. Cervix parous, pink and without discharge. Uterus anterior, midline, smooth, and not enlarged. No adnexal tenderness. Pap smear obtained. Rectovaginal wall intact. Rectal vault without masses. Stool brown and hemoccult negative.”

Introduction to Clinical Skills

Introduction to Clinical Skills

Groin ExamExamen de la Ingle Inguinal Region

Inguinal canal Inguinal rings

Femoral Region N A V E L

Introduction to Clinical Skills