Speculum Examination
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Mumtaz Adiba Bt Juanda ◽  
Suzanna Daud

Pelvic floor disorders, which includes pelvic organ prolapse (POP), have shown an increasing prevalence among women worldwide. (Wu 2014) It is perceived as embarrassment and affect the women’s quality of life. A 68-year-old housewife, Para 3, complained of a 50-cent coin size lump coming down from her vagina since 2019, which could be reduced back manually inside the vagina. The symptom exacerbated by straining and carrying heavy objects. Ignoring the symptom, causing the lump to increase in size and protruded out from her vagina for the past 2 months. She had 3 SVD with maximum birth weight of 3.75kg and a prolonged second stage of labour in her second pregnancy. She was not aware and never practiced pelvic floor exercise nor taken any HRT. There were no urinary symptoms nor constipation. Her BMI is 25.2kg/m2. Abdominal examination was unremarkable. On speculum examination, vagina was atrophic and third degree uterine prolapse was evident. She was arranged to have Vaginal hysterectomy, anterior colporrhaphy and sacrospinous fixation done. The positive risk factors in this case are multiparity, menopausal status, a history of prolonged labor and frequent heavy lifting. The delay in presentation is due to lack of awareness. It was also found in a study that feeling of embarrassment and social stigma could be the reason. (Abhyankar 2019) Pelvic Floor exercise and avoidance of heavy lifting may be beneficial at onset of symptom. For conclusion, POP awareness is crucial to empower women to prevent POP and seek treatment as soon as they are symptomatic.International Journal of Human and Health Sciences Supplementary Issue-2: 2021 Page: S24

Gupta Yogendra B. ◽  
Anand Kumar I. ◽  
Ramesh G. ◽  
Senthil Kumar S. ◽  
Sudhakar S. ◽  

Foreign bodies in the genitourinary tracts are not uncommon and is often a challenge to remove them from the bladder. This case is a peculiar one where there was a migration of a live fish from the vagina to the bladder. A 60- year- old post-menopausal woman while taking bath in a pond felt that there was an entry of fish into the vagina. Her complaints were pain and bleeding per vagina and there was no leakage of urine. At the peripheral health facility, she underwent exploration of the vagina under local anesthesia after placing the foley catheter which was draining blood-stained urine. The patient was then referred to us. There was a laceration at the right anterolateral fornix. Fish could be palpated with the finger. She underwent routine blood tests and CT KUB which revealed a foreign body at the right anterolateral side of the vagina. Cystoscopy showed a laceration of 1×1 cm noted in the posterior wall of bladder approximately 1cm above right ureteric orifice, through which the fish was seen. Through speculum examination, the rent was visible and the remnants of the fish were removed vaginally. Laparotomy and rent repair was done because of the rent in the bladder. Foreign bodies into the bladder are common and invariably seen among children, women who have psychiatric problems. Common foreign bodies seen are broomsticks, toothbrushes, pencils, gauze, sutures, clips, IUCD, etc. Fish as a foreign body is a very rare condition. The unusual entry of a fish into the vagina has eroded and entered the bladder. Prompt investigations like CT scans and cystoscopy can help in the removal of foreign bodies.

2021 ◽  
Vol 28 (08) ◽  
pp. 1156-1160
Hafiza Khatoon ◽  
Nousheen Mushtaq ◽  
Safia - ◽  
Fiza Ali Khan ◽  

Objective: To estimate the frequency of abnormal cervical cytology detected by Pap smear. Study Design: Cross Sectional Study. Setting: Department of Obstetrics and Gynaecology Gambat Institute of Medical Sciences Gambat, Khairpur Sindh. Period: November 2018 to June 2019. Material & Methods: A total of 160 women with the complaint of heavy vaginal discharge and moderate to servere lowere abdominal pain more than 6 weeks were included in this study. Per speculum examination of cervix was carried out with the help of cuscos speculum before PAP smear and finding were noted, After labeling the sample was sent to histopathology for cytological examination. Results: The average age of the patient’s was 37.68±7.46 years. Percentage of normal smears 10%, advance disease 1.3% and percentage of inflammatory smear is 63.8% while frequency of abnormal cervical cytology was observed in 25% in which CIN-1 was 12.5%, CIN-2 was 11.3% and CIN-3 was 1.3%. Conclusion: Our population have large numbers of undiagnosed cervical diseases. Therefore, Pap smear testing should be widely used throughout Pakistan to reduce the incidence of cervical cancer.

Dr. Samay Singh Meena ◽  
Dr. Badrilal Patidar ◽  
Dr. Girdhar Gopal Nagar ◽  
Dr. Sanjana Jourwal

Premature rupture of membrane (PROM) is defined as the disruption of fetal membranes before the beginning of labor, resulting in spontaneous leakage of amniotic fluid. The present study is undertaken to study the labor outcome, maternal morbidity and perinatal morbidity and mortality in term PROM. This is a Prospective Observational and Descriptive type Study conducted at Government Medical college, Kota for a period of eighteen month from January 2019 to June 2020. 200 cases of Spontaneous rupture of membrane with term gestation and confirmed by per speculum examination were selected. PROM was common in primigravida (62.50%), majority of belonged to age group of 20-29 years (89.0%). Need of induction required in 88% of cases, induction by cerviprime-gel done in 84.5% cases, Cesarean sections were more among primigravida. Failed induction was the common indication (44.11%). Maternal morbidity was significant (20.0%). Febrile morbidity was the major morbidity noticed with 14.50% followed by PPH 1.5%. No maternal mortality in the study. Perinatal morbidity was seen in 21% of cases. Birth asphyxia was the commonest cause for perinatal morbidity (14.0%). No Perinatal mortality was seen in this study. Escherichia coli (16.50%) was common organism found in culture of amniotic fluid. Majority of babies had APGAR score 6 &7 at 1 minute of birth and APGAR score 9 and 10 at 5 min. of birth. PROM is associated with many complications which can be reduced, by educating the women to have regular antenatal care, and early recognition of genital tract infection, and treat appropriately and to report at the earliest.

Fouzia Rasool Memon ◽  
Nusrat Fozia Pathan ◽  
Asma Naz ◽  
Hazooran Lakhan ◽  
Shahida Baloch ◽  

Background: Outpatient hysteroscopy is a safe, reliable and cost-effective alternative to hysteroscopy under a general anaesthetic for the diagnosis of abnormal uterine bleeding. Objectives: The objective of this study was to introduce new technique of pseudo-vaginoscopy for better movement of hysteroscope and less procedural pain. Also to assess acceptability of patients for outpatient hysteroscopy when appropriate analgesia was given prior to the procedure. Methodology: A prospective study was conducted of 74 women attending for outpatient hysteroscopy at the West Cumberland Hospital over a period of one year. Selection criteria include very narrow and atrophic vagina and failed speculum examination in gynaecology outpatient clinics. Results: Of the women studied, 95.5% stated that they would recommend the procedure to friends in future, whilst 5.8% would not want to go through it again. The type of anaesthetic administered during the procedure seem to influence whether women would attend for outpatient hysteroscopy in future. Conclusion: Our pseudo-vaginoscopic approach allows more freedom for the scope movements not limited by the speculum with the advantage of prior cervical preparation.  It was certainly at value for operative outpatient hysteroscopy in patients with very high BMI where access was difficult owing to depth.

2021 ◽  
Vol 10 (16) ◽  
pp. 1177-1178
Jayanthi R. ◽  
Iysverya G.T ◽  
Nishanthi Chandru

A 52-year-old female patient, para 2 live 2, who attained surgical menopause 10 years back, presented to the outpatient department (OPD) with complaints of white discharge per vagina for 6 months, which was watery in consistency and was not associated with foul smell or itching vulva. She had history of hysterectomy done for fibroid uterus 10 years back. On examination, she was afebrile and vital signs were within normal limits. Per abdomen examination, was normal, while, per speculum examination revealed a watery discharge per vaginum. The per vaginal examination revealed a firm, non-tender, globular mass felt arising from the vaginal vault and the mass did not bleed on touch. A globular mass of size 3 x 4 cms, pinkish white in colour, was seen occupying the whole of the vaginal vault with curdy white precipitates in the vaginal rugosities as well as over the mass.

Medicina ◽  
2021 ◽  
Vol 57 (3) ◽  
pp. 207
Gina Nam ◽  
Sa Ra Lee ◽  
Sung Hoon Kim ◽  
Hee Dong Chae

Uterine incarceration is rare, but it can caus e serious complications, in which the uterus is trapped in the pelvic cavity behind the sacral promontory. Fibroid uterus can cause urinary frequency and retention, which can result from compression of the urinary bladder with an enlarged fibroid uterus and the compression of the bladder neck or urethra, respectively. To our knowledge, there is no report on prolonged complete urinary obstruction because of an incarcerated uterus in nonpregnant women to date. A 51-year-old woman was referred for uterine myomas. She could not void for 30 months after she received an intradetrusor injection of botulinum toxin for urinary frequency management at the urology department of another hospital. She underwent clean intermittent catheterization for 30 months. She was referred to the gynecologic department for the evaluation of uterine myoma found on using abdominopelvic computed tomography. On physical examination, the uterine cervix was extremely displaced in the upward direction and was not exposed on speculum examination. Sonography and magnetic resonance imaging revealed that the urethra and the bladder neck were compressed by an extremely retroflexed fibroid uterus. Manual reduction of the incarcerated uterus failed; hence, we performed robot-assisted laparoscopic total hysterectomy with left salpingo-oophorectomy. She immediately urinated immediately after the operation and had normal urination at 1- and 48-month follow-up visits. Uterine incarceration by a fibroid uterus can cause complete urinary obstruction, as in this case. Uterine incarceration should be considered in women with urinary frequency or retention to avoid prolonged, serious complications.

2021 ◽  
Vol 14 (2) ◽  
pp. e238427
Pruthwiraj Sethi ◽  
Girija Shankar Mohanty ◽  
Supriya Kumari

Postpartum genital tract adhesions are infrequent and exact incidence is not reported. Severe dystocia, obstructed labour and frequent pelvic examinations have been proposed as possible causes of vaginal adhesion following vaginal delivery. Atresia/adhesions of vagina following caesarean section is very rare. Here, we report a rare case of 21-year-old P1L1 woman presenting with secondary amenorrhoea associated with cyclical abdominal pain following caesarean section. Per speculum examination showed a blind vagina with no communication with the upper one-third. We created a neovagina after adhesiolysis. We hope to increase the awareness of the obstetricians around the globe about postpartum genital tract adhesion, which may even occur as a rare secondary complication of caesarean section. We also wish to bring to the light of obstetricians that numerous pelvic examinations or difficult vaginal delivery may lead to genital tract trauma, and thus, must be minimised in an attempt to prevent postpartum genital tract adhesions.

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