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The speculum exam
- 2018/06/07
- 13:06
A speculum is a tool for looking inside a woman’s vagina. The speculum holds the walls of the vagina open. When it is in the right position, you will be able to see the cervix, test for infection or cancer, insert an IUD, or empty the womb.
A smaller speculum may work best for young women, women who have never had sexual intercourse, older women who are in menopause or who are not having regular sexual intercourse.
Help the patient relax by touching her leg, asking her to breathe, and by being gentle and slow. Remind her to tell you if the speculum hurts and stop the exam if you hurt her.
「それでは、検査の為に、器具を膣内へ入れますよ～。ゆっくり息をして、リラックスして下さい。若し、痛かったら遠慮無く申し出て下さい。我慢しないで下さいね。」
Ask the woman if she is ready to start. When she is ready, gently open the lips of her genitals with one hand so that you can see the opening of her vagina. Make sure to explain everything you are doing as you do it.
Hold the speculum with your other hand. Turn the handle to one side, and slide the closed bills into the vagina. If you are gentle, the bills will slide downwards into the vagina and should not hurt the woman.
As you put the speculum in, turn it so the handle is down. Be very careful not to pull her skin or hairs. Gently push the speculum all the way in. The handle should rest against the skin between the vagina and the anus.
Open the bills of the speculum by gently pushing the thumb-rest with your thumb. When you see the cervix between the bills, tighten the screw on the thumb-rest to keep the speculum open.
If you open the speculum but you do not see the cervix, close the speculum and remove it partway. Then try again, repeating step 4. The cervix may be off to one side a little. This is normal. Sometimes the cervix will come into view more clearly if the woman coughs or pushes down as if she is passing stool while the speculum is open inside her.
Look at the cervix — it should be smooth and pink, or, if the woman is pregnant, a little blue.
Small, smooth bumps on the cervix are usually normal, but sores or warts are signs of infection.
Notice if there is discharge or blood coming out of the cervix. Thin, white, or clear discharge is usually normal and healthy. Green, yellow, gray, lumpy, or foul-smelling discharge can be a sign of infection.
受診中の新患女性は、足元でカラカラと検査器具が音を立てるのを聞きます。同時に下腹部に圧迫感を覚えて、体に力が入ります。ボソボソと会話も聞こえて来ます。カーテンの向こう側では、何かを受け渡ししているようです。ドクターが話し掛けると、チクチクとした痛みを感じました。
ネット上で見つけたクリニックで、相談して予約して来てみたのですが、都心の雑居ビルにある、小さなクリニックでした。やっぱり大学病院へ行けばよかったかなあと、後悔をします。どうして内診室に、こんなに人の出入りがあるのかしら？
この画像では、角度が悪くて、内部が見えませんが、奥のやや上側に、子宮頚部が見えていました。白いものはオリモノで、正常な膣の機能です。更にｂｉｌｌｓ（嘴）を開いて、大きく子宮頚部を露出させてから、ヘラやブラシ等で細胞診を行います。次回は、Ｌサイズの膣鏡を用いて、もう少し見え易くしましょう。
「はい、膣鏡診は、終わりですよ～。ちょっと痛かったかな～？ 次は、内診しますね～。」
抜いた膣鏡は、温かくてオリモノとバルトリン腺液で、ベトベトになっています。性器も結構濡れて肛門へと垂れています。続いて、膣内診を行います。
A smaller speculum may work best for young women, women who have never had sexual intercourse, older women who are in menopause or who are not having regular sexual intercourse.
Help the patient relax by touching her leg, asking her to breathe, and by being gentle and slow. Remind her to tell you if the speculum hurts and stop the exam if you hurt her.
「それでは、検査の為に、器具を膣内へ入れますよ～。ゆっくり息をして、リラックスして下さい。若し、痛かったら遠慮無く申し出て下さい。我慢しないで下さいね。」
Ask the woman if she is ready to start. When she is ready, gently open the lips of her genitals with one hand so that you can see the opening of her vagina. Make sure to explain everything you are doing as you do it.
Hold the speculum with your other hand. Turn the handle to one side, and slide the closed bills into the vagina. If you are gentle, the bills will slide downwards into the vagina and should not hurt the woman.
As you put the speculum in, turn it so the handle is down. Be very careful not to pull her skin or hairs. Gently push the speculum all the way in. The handle should rest against the skin between the vagina and the anus.
Open the bills of the speculum by gently pushing the thumb-rest with your thumb. When you see the cervix between the bills, tighten the screw on the thumb-rest to keep the speculum open.
If you open the speculum but you do not see the cervix, close the speculum and remove it partway. Then try again, repeating step 4. The cervix may be off to one side a little. This is normal. Sometimes the cervix will come into view more clearly if the woman coughs or pushes down as if she is passing stool while the speculum is open inside her.
Look at the cervix — it should be smooth and pink, or, if the woman is pregnant, a little blue.
Small, smooth bumps on the cervix are usually normal, but sores or warts are signs of infection.
Notice if there is discharge or blood coming out of the cervix. Thin, white, or clear discharge is usually normal and healthy. Green, yellow, gray, lumpy, or foul-smelling discharge can be a sign of infection.
受診中の新患女性は、足元でカラカラと検査器具が音を立てるのを聞きます。同時に下腹部に圧迫感を覚えて、体に力が入ります。ボソボソと会話も聞こえて来ます。カーテンの向こう側では、何かを受け渡ししているようです。ドクターが話し掛けると、チクチクとした痛みを感じました。
ネット上で見つけたクリニックで、相談して予約して来てみたのですが、都心の雑居ビルにある、小さなクリニックでした。やっぱり大学病院へ行けばよかったかなあと、後悔をします。どうして内診室に、こんなに人の出入りがあるのかしら？
この画像では、角度が悪くて、内部が見えませんが、奥のやや上側に、子宮頚部が見えていました。白いものはオリモノで、正常な膣の機能です。更にｂｉｌｌｓ（嘴）を開いて、大きく子宮頚部を露出させてから、ヘラやブラシ等で細胞診を行います。次回は、Ｌサイズの膣鏡を用いて、もう少し見え易くしましょう。
「はい、膣鏡診は、終わりですよ～。ちょっと痛かったかな～？ 次は、内診しますね～。」
抜いた膣鏡は、温かくてオリモノとバルトリン腺液で、ベトベトになっています。性器も結構濡れて肛門へと垂れています。続いて、膣内診を行います。
