Performing The Exam  

gynodoc6911 55M
8 posts
5/17/2006 5:09 pm
Performing The Exam

This is the general procedure I use when performing an exam. I know there are many "Doctors" out there and everyone does things differently, but this seems to work best for me.
I have been doing mostly house calls lately because, although I have a body piercing shop with a beautiful gyno table, I have had some near catostrophic close calls with employees showing up at inconvenient times. on the up side, it does give me access to the autoclave to keep everything sterile.
Upon arrival, I give the patient a cotton gown and ask her to change into it while I get out my instruments and prepare for the exam. As the doctor, you must keep in mind that while a gynecologist would want to minamize apprehension, you do not necessarly want to do so. lay out your equipment and let her SEE it. This is a big part of it for her. I begin by asking her some questions. I have a form I fill out, and actually make a "file" for each patient so I can see what we have explored, and her general history. I ask about allergies. This is important because I use latex gloves, If she is allergic to latex, I will use non-latex gloves and make a note in the chart. I also occasionally use lidocaine jelly, and benzocaine, so allergies are important. After going through my questionare, I begin by taking her pulse, respiration, and blood pressure. Take your time, this is an important part of the exam, giving her time to think about what is happening. I claen the head of my stethoscope with an alcohol pad, She will find the smell of the alcohol familiar, I use my stethoscope, opening the back of the gown and listening to her lungs. Remember, take your time. Unless the stethoscope is very cold, I do not warm it, I want her to feel the coldness of the stethoscope as I listen to her lungs. I have her face me and look streight ahead as I check her pupils with my penlight.I palpate the lymph nodes in her neck,and notice any enlargement or tenderness. I use a toungue depressor, and check her throat with my penlight. Do not insert the tongue depressor too far back, she will gag,and its not nice. I then use my otoscope and check her ears, Gently pull the ear lobe backwards and insert the otoscope. I then go back to my stethoscope, this time opening the front of the gown and listening to her heart. By now, she is done being terrified,but is still quite apprehensive. I ask her to lay down on her back, and put one arm behind her head, and begin the breast exam. DONT stare at the breast. I carefully work my way over the breast and into the armpit noting any tenderness or abnormal lumps in the lymph nodes. I Lightly squeeze the nipple and notice any drainage.I Perform the exam on the other breast using the same technique. When I am done,I replace the gown, and make a notation of my findings in her chart. I then open a 4X4 sponge and squeeze some surgilube on it. I get out my rectal thermometer, clean it with an alcohol swab, place the tip in the surgilube, Prepare a guiac slide and place the bottle of developer by the slide.and glove my hand (Im left handed, so I glove my left hand) It is important to let her watch you do this, remember, for her, this uses all her senses, she smells the alcohol, she sees you preparing the equipment, she hears the surgilube coming out of the tube, and hears the glove being put on.I ask her to roll over onto her side, and with the ungloved hand, gently seperate her buttocks and insert the thermometer with the gloved hand, and while holding it in place, cover her with the gown. I normally rest the unused hand on her hip.I leave the thermometer inside her for about 2 minutes. I take this time to ask her questions , but I keep it light hearted,(DO NOT whistle a tune to yourself, use this time to talk with her.) When about 2 minuites have elapsed, I remove the thermometer and read it. Then I Tell her I am going to perform a quick rectal exam.I Lubricate the index finger of my gloved hand and while asking her to bear down, insert it fully into her rectum. moving the finger around in the rectum, I pay attention to any masses felt,also, the tone of the muscles. (this will help to determine her willingness/ ablilty for more invasive anal procedures later.If she expresses discomfort,I re-assure her in a soft calming voice. Remove the finger and ask her to roll back over onto her back.I do not wipe off the lube. I let her feel it for a bit.I then wipe the fingertip of the gloved finger onto the guiac slide and add a few drops of developer.If the slide turns blue,I make a notation in her chart. Now I lift up the gown and listen to her bowel sounds with the stethoscope.I Palpate the abdomen firmly but not so deeply as to cause any extreme discomfort, and Note any abnormalities on her chart (tenderness, ect)

Now we get to the pelvic part of the exam. Up to this point, the exam is exactly the same for a genetic girl as it is for a transgender girl. Since over a third of my patients are transgendered women, I will detail the pelvic exam for both in seperate posts. I hope I have stressed the importance of taking your time, and stimulating all her senses, as this is very important for her enjoyment, which is, after all, why were doing this.


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