Author: Sister Sa (attending doctor of obstetrics and gynecology)
Say something interesting.
I am a fair-skinned, beautiful, big-breasted little sister who has been in the United States and is usually very timid. The day before yesterday, I felt a little uncomfortable in my stomach, accompanied by frequent urination, so I wanted to see a doctor.
After seeing the doctor, the first thing is to complain to me:
This “next year” is really incapable of complaining. At the same time, if you touch your stomach and say that you have ovarian cysts, it is indeed a bit arbitrary, but considering that they have to do a B-ultrasound in advance It’s no wonder that appointments are made for one year. Seeing a doctor depends on hand and guess.
Compared to people who calculate the waiting time for medical treatment in “years”, do you think the long queues in our major hospitals seem less scary?
However, even if we enjoy the convenience that we can check almost anytime we want, what kind of B-ultrasound, CT, basically we can do it on the same day, it cannot completely replace the doctor “manual” checks.
Sister Sa, I received a consultation from a girl before, saying:
Sister, I was going to see the gynecologist, but the doctor stabbed the chrysanthemum. That feeling is really sour!
Although I understand the truth, I just want to ask:
Why are you stabbing my chrysanthemum? Shouldn’t this be the job of a proctologist?
I can imagine her unrequited expression through the phone, but in fact, the gynecologist really needs to poke chrysanthemum sometimes, and it may be Poke front and back together.
This brings us to two gynecological examinations that you may not be familiar with:
One, called bimanual.
Bimanual diagnosis is aimed at female patients with a history of sexual life. It is an important item in the female pelvic examination, and it is also an important item for gynecologists to That said, the basic skills that need to be mastered.
During the examination, the doctor will use the index and middle fingers of their dominant hand, one or two fingers, to penetrate into the vagina and place them in the position of the cervix or posterior fornix. At the same time, the other One hand will cooperate with the abdomen. Under the premise of the patient’s comfort, use the abdominal hand to press the abdominal wall to push down the pelvic organs, and at the same time, the hand in the vagina will lift it up, and combine the movements to feel the uterus touched between the two hands. , and in the case of attachments.
Image source: Zhanku Hailuo
For the purpose of bimanual examination, it is usually used to examine the vagina and uterus to assess the size, shape, symmetry, mobility, position and texture of the uterus, and to palpate the vagina and cervix. , uterine body, fallopian tubes, ovaries, uterine ligaments and connective tissue adjacent to the uterus, to know whether there is tenderness and palpable abnormal masses.
For example, under normal circumstances, the ovaries are located deep in the pelvis, and normal ovaries and fallopian tubes should not be touched. If you feel the ovaries or fallopian tubes, unless you are thin women, accidentally The ovary can be touched, the size is about 3cm2cm1cm, and there will be some soreness when palpated.
The size and texture of the uterus are related to the reproductive status of women, such as whether they have given birth to children and whether they are menopausal. There are several changes in the normal position of the uterus. Generally speaking, the axis of the uterus should be aligned with the The vagina is the same and can be tilted and flexed in the same direction. For example, most women are in the common anteversion and flexion position.
If the ovary is palpable, it is necessary to see if the ovary is of appropriate size and mobility. For postmenopausal women, palpable ovary is not a “normal” phenomenon. This condition is only seen in about 30% of postmenopausal women and generally requires further investigation, however, most are benign lesions or no lesions.
The palpability of the ovaries during an in-office clinical examination depends on several factors, including: the patient’s size, the examiner’s experience, when the examination was performed, and the presence of other pelvic abnormalities condition. Even under ideal conditions, when performed by an experienced clinician, it is difficult to reach the ovaries.
So, those who touch and say that your ovaries need to be “detoxed” are fooling you.
In fact, the sensitivity of bimanual examinations is relatively low, generally lower than 60%, in the detection of general adnexal masses or the differentiation of malignant and benign masses. Therefore, it is basically a preliminary examination. After a lump is found, it is still necessary to use other auxiliary examinations in time to more clearly identify the situation of the lump, such as B-ultrasound or MRI.
Maybe you may ask, bimanual fingers are inserted into the vagina, so what is poke chrysanthemum?
That’s the triad.
Gynecological evaluation may also require three-way diagnosis. The extra one is from the chrysanthemum, which is the anus diagnosis. The three-finger is theCombined abdominal, vaginal and rectal examinations.
Image source: Zhanku Hailuo
Tri-manual examination can be used as a complementary examination to bi-manual examination for better palpation of the recto-uterine pit, the uterosacral ligaments, and the uterus and its appendages.
In women who are not sexually active, or who are unwilling to perform vaginal bimanual examination, or who have other reasons not to have vaginal palpation, the nearest recto-abdominal examination is an alternative This method is especially important for patients with congenital hymen atresia, vaginal or cervical atresia.
If triage is performed, anorectal findings (eg, hemorrhoids, rectal mass) should be recorded. Occult blood tests can be performed on stool on examination gloves if desired, however, if your purpose is to screen for colorectal cancer, a single sample may not be sufficient for colorectal cancer screening; it may be better to collect a stool sample at home complete this screening.
During the triadic consultation, the doctor will use lubricated examination gloves, one finger is inserted into the vagina, one finger is inserted into the chrysanthemum, and the abdominal hand is used to palpate. You cooperate with movements, such as telling you to push hard, trying to expel your fingers like a baba, which usually relaxes the sphincter and reduces discomfort.
Why can’t the same finger be used to inspect a vagina and poke a chrysanthemum?
Of course not, on the one hand for hygiene reasons, but also to avoid human papillomavirus (HPV) transmission or blood contamination, because if both use the same finger, then it is possible Change the results of the fecal occult blood test.
Why is it so troublesome, why not just come up and do B-ultrasound?
Although imaging examination may be an easy task for us, as the basic skill of gynecological examination, doctor’s palpation is a preliminary diagnosis, which can reduce unnecessary examinations and avoid More waste of medical resources.
In addition, for patients in the United States who have to wait a year for a B-ultrasound, if the doctor does not even do a bimanual or trimodal diagnosis, it can be said that It is even more tragic. It is estimated that this medical treatment really only depends on “seeing”!
So, Sister Sa knows you must be curious: what does it feel like to poke a chrysanthemum?
Although my sister Sa did not stand on the operating table too often, but when it comes to the basic skills of poking chrysanthemums, I think I have passed the technical test.
In general, some people are looser, while others are tighter. After passing through the door, it is like a boat passing through the entrance of the cave, and you will feel the warm and pleasant subtropical hot spring. With a tight contraction, and the faint smell of ecstasy after coming out.
Poke is not the same as being stabbed.
Sometimes I say this, Sister Sa, don’t think I am exaggerating:
Be content, comrades, you must cherish your current life, the B-ultrasound that you don’t like, people may not be able to do, and being able to get a chrysanthemum by a doctor is a kind of Happy too!
References:
[1] Evantash E. Lubricant use during Pap test collection. Hologic Inc, Bedford, MA 2009.
[2] Ueland FR, Depriest PD, Desimone CP, et al. The accuracy of examination under anesthesia and transvaginal sonography in evaluating ovarian size. Gynecol Oncol 2005; 99:400.
[3] Myers ER, Bastian LA, Havrilesky LJ, et al. Management of Adnexal Mass. Evidence Report/Technology Assessment No.130 (Prepared by the Duke Evidence-based Practice Center under Contract No. 290-02-0025). AHRQ Publication No. 06-E004, Agency for Healthcare Research and Quality, Rockville, MD February 2006.
* This article is reproduced with the authorization of the WeChat public account Doctor Girl Zhengzhuan.