Inspection tools

Gynecological examination the patient can not be limited only to the outer and inner exploration. It must be supplemented by methods of inspection found pelvic organs with the help of certain tools.
Most often performed inspection by mirrors. The doctor, the midwife owe this study to make every gynecological sick, which was about a particular disease in a hospital, clinic or health center. Often only by this method of research can be identified suspected malignancy of erosion. Vaginal mirrors for their construction can be divided into three types: cylindrical, sash and spoonlike.
Cylindrical mirror (Fig. 33) have the form of tubes of various sizes, one end of which has the shape of a bell, and another cut. They are produced from glass, plastic or metal.
The study is as follows: take a mirror of the appropriate size with the right hand, putting the thumb on the inside of the mirror from the socket (34). Thumb and index finger of the left hand disclose sexual slit and enter the end of the mirror in the vaginal entrance, pushing crotch and holding the longer wall mirrors backwards.
Since the area of the urethra and the clitoris is the most sensitive, with the introduction of mirrors special care is needed. Then by rotational motions of a mirror promote deep down until the end it will not run into the vaults, and the vaginal portion of the cervix is not inserted into the lumen of the tool. Cylindrical mirrors convenient not only for the purposes of inspection of the vaginal walls and vaginal portion of the cervix, but also for therapeutic purposes, namely for lubrication of cervical and other
If you want to apply a sliding mirror, it is best, especially in outpatient practice, to use folding mirror Cuzco (Fig. 35).
Introduction mirrors in the vagina as follows: after expanding labia mirror folded enter the vagina so that the bill it was located slanted clinico genital slit. Entering the mirror half his turn so that one leaf was turned back, and the other to the front.
Arm mirrors should be turned down, not up (to fold), as in the screw on the handle can get the hair covering the pubic area, and thus to cause pain to the patient. Pushing the mirror deep and bringing together the branches of the handle screw, reveal the cervix for examination or production is scheduled manipulation.
Spoonlike mirrors consist of spoons and handle. Mirrors of this type are used most widely: moving them at will, you can see all the departments of the vagina, its walls, arches and neck cancer. During examination of vaginal part of cervix pay attention to the shape, size, color, length of the front and back of the lips, the shape of the external OS and available modifications (tears of cervix, erosion, ulcers, polyps, etc). Using a spoonlike mirrors we can manipulate in the depth of the vagina and on the cervix and make one or the other vaginal surgery. Mirrors are of different lengths and shapes. In some models spoonlike mirrors spoon forms with arm inseparably: such, for example, mirrors Sims (Fig. 36). In most cases, apply mirrors, spoon which are connected with arm through the castle; these are the mirror Simon (Fig. 37) and Fritsch (Fig. 38). During examination of the vagina and vaginal portion of the cervix using a spoonlike mirrors need to have a lift (Fig. 38 and 39). The inconvenience of applying spoonlike mirrors is the need to have an assistant for their detention.
For diagnostic purposes is used for inspection of suspicious lesions on the cervix and vagina of a special device - a colposcope (Fig. 40). This device makes it possible to thoroughly explore the mucous membrane of the vagina and cervix with the increase in 10-15 times, and identify the most suspicious places from which you want to take a piece for histological testing (biopsy).
For drying of the vaginal walls and operating margins at vaginal operations tampons capture long tongs - kinsangani or long tweezers (20 cm length).
In the study of mirrors may require some additional tools that, like a mirror, before use, be sure sterilized by boiling. For cleaning the walls of the vagina and cervix necessary small gauze balls, which are captured in the long gynecological tweezers - anatomical or surgical.
For diagnostic purposes, as well as for various manipulations on the neck, the latter sometimes have to capture and bring to the entrance to the vagina. For these purposes, used or bullet forceps, with one sharp spike on each branch, or tongs, Muso, having on each branch on two teeth in the form of a fork.
In cases when you need to produce lubricating whatever medicinal substance mucous membrane of the cervix or uterus, used a long metal stick, on thin end of which include cutting, making wound gauze or cotton wool stays tight.
In some cases, for diagnostic purposes (examination of uterine cavity using outerscope, kurikoma, sensing), as well as therapeutic interventions (injection into the uterus of drugs, diagnostic scraping, introduction of radium and so on) used the pre-expansion of the cervix. For these purposes are used extenders Gagara. They are cylindrical, bent multiple axis metal sticks with conically narrow and rounded ends. The other end of the extender flat cut, and on it is a number that shows the diameter of the expander in millimeters. Usually a set of dilators starts with number 3. The rooms are of whole and half (for example, number 4, and 4.5, 5, and so on). Extenders are formed and served doctor in numerical order.