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We present the case of a 26-year-old woman with retained fetal bones, discovered eight years after an induced mid-trimester abortion in a West African country. The patient had requested her general practitioner to change the intrauterine device (IUD) which she assumed had been inserted immediately post-abortion. No threads were seen on vaginal examination. A pelvic ultrasound examination showed features that were misinterpreted for an IUD in the cervical canal. At evacuation of the uterine cavity retained fetal bone fragments were recovered.

Birth, whatever its origins and associations, is normally a celebratory event, which, in ideal circumstances, could serve to counterbalance critical responses to non-normative childbearing. That young motherhood is seldom understood as an event to celebrate has been noted (Baker, 1999); indeed, narratives of labour and birth suggest that, to the contrary, these appear troubling events for maternity staff. Once the charged family atmosphere which accompanied pregnancy disclosure had subsided, most of the teenagers looked forward to becoming mothers and stated an intention to do the best they could for their child’s welfare. Their journeys through pregnancy, however, were made more difficult by the stigmatising attitudes they faced, not least from health professionals; many young women thus approached labour with a mounting sense of dread. Mothers were also anxious, especially those with painful memories of their own labours, and the cruel treatment they had received from maternity staff.

Videotapes of women during the second stage of labor and their caregivers were examined in this descriptive study to determine how caregivers performed sterile vaginal examinations. Conversational analysis techniques were used to analyze the data. Results showed that the examinations were performed in a ritualistic manner by all caregivers, and the way the ritual was enacted repeatedly demonstrated the power of the caregivers over the women. The most common reason for performing the procedure, to help the woman push better, seems to be specific to the second stage of labor and is not described in the literature. The authors offer suggestions for better use of the examination, and recommend that it be performed far less frequently than is common.

O ciclo estral da cadela se divide em fases sucessivas e individualizadas, sendo elas: proestro, estro, metaestro e diestro, seguido de anestro. Estas fases podem ser diferenciadas por exames hormonais ou citológicos, o que permite estimar o período de fertilidade, distúrbios do ciclo estral e inatividade sexual. Desta forma, o presente trabalho teve o intuito de realizar exames citológicos vaginais em cadelas e identificar seus escores reprodutivos. Para tanto, foram realizados exames em 91 fêmeas escolhidas aleatoriamente, durante a campanha de vacinação anti-rábica na cidade de Ituverava-SP, sendo encontrados 14,2% destes animais em proestro; 23,0% em estro; 3,2% em diestro e 52,7% em anestro.

Background Post caesarean wound infection is not only a leading cause of prolonged hospital stay but a major cause of the widespread aversion to caesarean delivery in developing countries. In order to control and prevent post caesarean wound infection in our environment there is the need to access the relative contribution of each aetiologic factor. Though some studies in our environment have identified factors associated with post caesarean wound infection, none was specifically designed to address these issues prospectively or assess the relative contribution of each of the risk factors. Findings Prospective multicentre study over a period of 56 months in Lagos Nigeria. All consecutive and consenting women scheduled for caesarean section and meeting the inclusion criteria were enrolled into the study. Cases were all subjects with post caesarean wound infection. Those without wound infection served as controls. Data entry and analysis were performed using EPI-Info programme version 6 and SPSS for windows version 10.0. Eight hundred and seventeen women were enrolled into the study. Seventy six (9.3%) of these cases were complicated with wound infection. The proportion of subjects with body mass index greater than 25 was significantly higher among the subjects with wound infection (51.3%) than in the subjects without wound infection (33.9%) p = 0.011. There were also significantly higher proportions of subjects with prolonged rupture of membrane (p = 0.02), prolonged operation time (p = 0.001), anaemia (p = 0.031) and multiple vaginal examinations during labour (0.021) among the women that had wound infection compared to the women that did not have wound infection. After adjustment for confounders only prolonged rupture of membrane (OR = 4.45), prolonged operation time (OR = 2.87) and body max index > 25 (2.34) retained their association with post caesarean wound infection. Conclusion Effort should be geared towards the prevention of prolonged rupture of fetal membrane and the reduction of prolonged operation time by the use of potent antibiotics, early intervention and use of good surgical technique. In obese women improved surgical technique and use of non absorbable sutures may suffice.

An adult Dorper ewe was presented to the Large Animal Clinic with dystocia. Reddish masses were seen hanging from the vulva of the ewe. Vaginal examination revealed a deformed fetus in the pelvic cavity that left insufficient room for fetal manipulation. A tentative diagnosis of dystocia due to fetal deformity was made. The dystocia was relieved by cesarean section and a case of true schistosomus reflexus in a lamb was confirmed from physical examination of the defective fetus.

The purpose of this study is to examine the inter-observer reliability of the pelvic organ prolapse quantification (POP-Q) system in left lateral position.Women attending urogynaecology outpatient clinics were examined in the left lateral position using a digital examination and POP-Q. This was repeated separately by a second blinded clinician. The inter-observer agreement was calculated using the Cohen's kappa coefficient. The POP-Q examination was then performed with a woman lying in dorsal lithotomy position. The POP-Q findings in the two positions were compared.Two hundred and eighteen women were recruited. The digital examination had a moderate inter-observer reliability with a kappa value of 0.54. The POP-Q showed a high degree of reliability (0.88). There was a high degree of correlation between the POP-Q findings in left lateral and lithotomy position (rho0.95, p0.001).The POP-Q in the left lateral position is reliable, easy to perform, acceptable for patients, and is not a time-consuming examination.

Recurrent mechanical fissure of the posterior fourchette, previously termed vulvar granuloma fissuratum by Kennedy et al. [1], is characterized by recurrent superficial splitting of the mucosa with severe pain on vaginal penetration particularly with intercourse and vaginal examination [1]. While recurrent fissure of the posterior fourchette is not uncommon, references are scarce concerning this condition [2,3]. Anecdotal evidence suggests that most gynecologists have encountered patients with this disorder. Furthermore, description has been primarily clinical or associated with pathologically confirmed specific diagnoses such as lichen sclerosus and atrophic dermatitis [3].

The traditional method for assessment of cervical dilation―vaginal examination―is subjective and has an accuracy of less than 60%. Although several devices for cervical dilation assessment have been developed, few have survived and cervical assessment is still performed by vaginal examination worldwide. This prospective study compared the accuracy of clinical measurement of cervical dilation for 2 methods, vaginal examination and use of a position-tracking system. The study subjects, enrolled at 3 centers (Poissy, France; Brooklyn, NY; and Haifa, Israel), were 188 singleton women in active labor with vertex presentation and no known contraindication to vaginal examination. For each routine vaginal examination, a sensor was attached to the midwife's index fingertip and measurement was performed with a magnetic position tracking system, using personal computer-based controlling software, and ultrasound imaging technology. A total of 333 measurements were performed with the tracking system. Ninety cases with clinically full dilation were excluded from analysis. The data from the 3 centers were pooled; results were similar in each. There was an overall mean absolute difference of 10.2 ± 8.4 mm between the 2 methods. Analysis of subgroups stratified by dilation showed that the absolute difference was 7.5 ± 7.3 mm (70.0% accuracy) when the cervical dilation was >8 cm and 12.5 ± 8.7 mm (38.8% accuracy) when the cervical dilation was between 6.1 and 8 cm. These findings show that the accuracy of the positron-tracking system for assessment of cervical dilation during labor appears to be limited. The clinical relevance of this system in routine care is unclear and requires further evaluation.

The routine wearing of individual cover gowns by nurses and visitors for direct care of healthy newborns was usual practice on the maternity ward of a regional referral center. We conducted a randomized trial in which cover gowns were not provided for care of infants in the experimental group (n = 222), but were maintained for control infants (n = 230). The principal outcome measured was Staphylococcus aureus colonization of the newborn nares or umbilicus on day 3 or day of discharge. Twenty percent (n = 51) of the experimental group (no gown) had a positive culture compared with 21 percent (n = 47) of the controls. Of the infants with positive cultures, two in each group exhibited symptoms of overt S. aureus infection. Experimental infants were similar to controls with respect to feeding method, route of delivery, amount of time spent rooming-in, and average number of visitors per day. In the group of positively cultured infants, the mothers experienced longer labor, and more vaginal examinations in labor, and the number of males undergoing circumcision was higher. We concluded that routine use of cover gowns was unwarranted, and we have altered the ward policy accordingly. This also has had a positive economic effect.

We compared urodynamic findings and results of lateral cystourethrography in 82 patients with incontinence. The aim of the study was to establish a possible correlation between anatomic findings and functional results. Clinically, a significantly higher increase of the posterior urethrovesicular angle was noted in patients with a urodynamic stress incontinence than in patients with urge incontinence or those with normal urodynamic findings. Lateral cystourethrography as compared to urodynamic assessment, proved to be a method with high sensitivity (91%) but little specificity. These two methods supply different but complementary data. Together with history, assessment of patients' complaints, clinical vaginal examination, and clinical stress test they offer valuable information for an efficient therapeutic concept.

This study aims to compare digital vaginal examination with the patient in supine and standing position and to correlate the degree of pelvic organ prolapse (POP) with a prolapse quality of life (P-QOL) questionnaire. Two hundred and seven women with POP symptoms were digitally examined in supine and standing positions using a four-grade scale (none, minimal, moderate, and severe). P-QOL was used to assess the severity of prolapse symptoms. Cohen’s kappa coefficient was used to calculate the inter-observer agreement and Spearman rank correlation test to assess the correlation between examination findings and P-QOL scores. Only vaginal examination findings in standing position had a good inter-observer reliability (kappa value 0.76–0.91). The severity of P-QOL scores only correlated with the examination findings in the standing position (P < 0.001). Digital examination of POP is unreliable if woman is supine but is reliable and correlates with symptoms and QOL impairment when the examination is performed with the patient standing.

The patient was a fit and well 34-year-old woman with a history of a painless vulval lump, present for approximately 12 months, which had been slowly increasing in size. Abdominal and vaginal examination was unremarkable and the lesion was excised.

The Delhi government has revoked a circular it issued on 31 May, which suggested that hospitals in Delhi should perform the archaic two finger test on women who have been raped. The Times of India newspaper said that the government sent hospitals a circular stating that per vaginal examination, also known as the two finger test, could be conducted on such women “with their consent.” It said that doctors “cannot be made to function under the constraint of a complete ban of this …

The dilemma in the March issue considered the predicament of a vet who, during a follow-up vaginal examination, had discovered that a colleague had unknowingly caused a cow, from a good line, to abort a four-month-old conceptus. The colleague had inserted a progesterone releasing IUT and injected the cow with prostaglandin, after being called in by the farmer, who was concerned that this cow had not been seen in oestrus ( IP , March 2015, vol 37, pp 150–151). Gwen Rees noted that, as the farmer had not been present during the examination, the immediate temptation might be to say nothing, but that this would contravene the declaration all vets make on admission to the RCVS to ‘pursue the work of my profession with integrity’. She suggested instead being honest and asking the farmer if he was aware that his cow had been pregnant. She also stressed the importance of having accurate records in place and of making the practice aware of the situation as soon as possible. She added that it might be wise to contact the Veterinary Defence Society in case a complaint was made.

This case study discussed the successful method of management of buffalo uterine torsion. A number of 25 buffaloes with showing colic were taken suspected for uterine torsion at the Clinics of veterinarygynaecologyand obstetrics, CVAS, Bikaner. Uterine torsion was diagnosed by per rectal and per vaginal examinations. Priorly, we used plank method for manage torsion in buffaloes. Eighty percent buffaloes were successfully corrected by this method. 1–2 rolls were sufficient to detort in 60% buffaloes. After detorsion most cases were accompanied with closed or insufficient dilated (48%) than dilated or open cervix (32%) which were altered after drug therapy into opened (64%) and indilated cervix (16%). Caesarean section was needed in 36% cases including failed cases of detorsion by rolling (20%) and indilated cervix (16%) after successful rolling. After long-term follow-up, the study reported 88% and 4% survival rate for buffaloes and fetus, respectively in uterine torsion cases. On the basis of this study it was concluded that rolling with plank method is a satisfactory technique to detort the uterus.

A rare case of dystocia due to dicephalus monster with kyphosis and arthrogryphosis was recorded in a 5-year old crossbred cow presented with history of full term pregnancy, signs of labor since about 48 hrs, and unsuccessful pre-handling using unskilled traction. Vaginal examination revealed the presence of a dicephalic monster fetus with one of the heads severely damaged (broken jaw and damaged eye canthi). Caesarean section was performed and a female fetus with two heads, necks fused caudally, arthrogryposis in all the limbs and kyphosis was removed.

A two year old queen cat with history of overdue pregnancy, blackish green vaginal discharges with continuous straining was presented to the college clinic. Per vaginal examination revealed presence of dead fetus, which was diagnosed as a case of dystocia due to uterine inertia.Caeserean section followed by ovario hysterectomy, was performed. The cat recovered uneventfully without any complications.

Aims Major morphological abnormalities of the pubovisceral muscle are observed in 10–20% of women symptomatic of pelvic floor disorders. Such defects arise in childbirth and are associated with prolapse. While they are clearly evident on 3D ultrasound and MR imaging, such defects can be difficult to detect clinically. We intended to compare findings on palpation with the results of ultrasound imaging. Material and Methods Fifty-five women were recruited in a prospective observational study and assessed by interview, vaginal examination by a trained pelvic floor physiotherapist, and 3D/4D pelvic floor ultrasound. The vaginal examination involved digital assessment of muscle strength (modified Oxford grading) and morphological abnormalities. The ultrasound examination involved acquisition of volume datasets taken at rest, on Valsalva and pelvic floor muscle contraction. Assessments were undertaken supine and after voiding. Ultrasound operator and physiotherapist were blind to each other's findings. Results A comparison of 3D ultrasound and palpation was possible in 54 cases. Average Oxford grading was weakly associated with reduction in hiatal dimensions on contraction (r = −0.32, P = 0.024). A marked increase in hiatal dimensions detected on palpation was associated with increased hiatal area on Valsalva (P = 0.027). Defects were observed in 7/54 (13%) on ultrasound and in 10/55 (18%) on palpation. There was poor agreement between the methods, with only two defects picked up equally by both methods. Conclusions Palpation of the pubovisceral muscle correlates poorly with 3D/4D pelvic floor ultrasound imaging for the assessment of muscular defects. Neurourol. Urodynam. © 2006 Wiley-Liss, Inc.

A 47-year-old female presented with a 1 year history of continuous vaginal bleeding. Previously she had a regular cycle with mild menorrhagia. Bimanual and Cusco's vaginal examinations were apparen...

A 32-year-old female Indian patient presented with a 4-month history of flu-like illness troublesome bloodstained vaginal discharge and a swelling in her left lower limb. She had normal vaginal deliveries in the past and her periods were fairly regular. There was no history of any significant previous medical or surgical illness. There was no history of tubercular contact. A general examination revealed non-pitting oedema and thickened skin in her left thigh and inguinal region. Inguinal lymphadenopathy was also present on the left side. Vaginal examination showed a healthy cervix although a reddish brown discharge was noted. A cervical smear was performed. Full blood count erythrocyte sedimentation rate and a chest X-ray were all normal except for a raised eosinophil count (0.8 x 109 I/l). Serological examinations performed at the time were positive for filariasis. The cervical smear examination detected sheathed microfilarial larvae. The larvae measured approximately 300 microns in length and were nucleated throughout the central axis except for the terminal ends. An increased number of polymorph-nuclear cells were noted in the smear sample. (excerpt)

In this study, the efficacy of aglepristone and/or intrauterine antibiotic administration for the treatment of bitches with cystic endometrial hyperplasia/pyometra complex was investigated. Twenty-four bitches (5-12 years old) with the diagnosis of pyometra were treated at the University of Kafkas and at Istanbul University. The diagnosis of pyometra was established on the basis of the results of clinical, ultrasonographic and vaginal examinations, the haematological and biochemical findings and the history data. In Group I (n = 13), aglepristone (Antiprogestin, Alizine((R)), Virbac, France; 0.33 ml/kg, s.c.) was administered on days 1, 2, 7, and 14 (day 1: diagnosis). In Group 11 (n = 11), intrauterine antibiotic treatment was performed according to the antibiogram on days 1, 2, 4, 6, 8 in addition to aglepristone given as in Group 1. Clinical and ultrasonographic examinations, haematological results and occurrence of oestrous cycles revealed that the ratio of effectively treated bitches was 6/13 and 9/11 in Groups I and II, respectively.

The public revelation in 2003 that medical students perform intimate examinations without patient consent has engendered much debate in the press and scientific journals. Using this case as a springboard for discussion, I will argue that medical schools should encourage students to raise their ethical concerns and call for a change of policy making it easier for students to do so. I will also address the question of medical students’ moral obligations towards their patients, and conclude that medical students ought to express their discontent when faced with unethical practices or attitudes. In early January 2003, a study appeared in the British Medical Journal revealing that nearly a quarter of rectal and vaginal examinations on anaesthetised patients were performed by medical students without patient consent.1 Although the study did not generate the firestorm of controversy many expected, it engendered much discussion on ethical issues surrounding informed consent and patient autonomy, as well as stressing the need for greater ethics training for medical students. As an ethical problem, however, the case of intimate examinations is, to my mind, relatively uninteresting. If we agree that it is wrong for doctors to perform a vaginal examination on a conscious person without their consent, then it follows that it will still be …

Objective To determine whether hard or soft cervical models produced more accurate results when examined by practitioners of various experience levels. Study design Simulated hard and soft cervical models were placed in a chamber designed to simulate a realistic vaginal examination. These cervical dilation and effacement models ranged from 1 cm to 6 cm and from thick (4 cm) to complete (0.2 cm). Each examiner had 20 seconds to evaluate each of 12 models of varying dilation and effacement using the soft and then the hard models. Models of the same dilation and effacement were presented to each practitioner in the same sequence. Physicians, nurses, and residents did the cervical evaluations. Results Of 360 recorded dilation measurements, only 19% were exactly correct using the soft models, whereas 54% were exact using the hard models. The percentages correct using hard cervix models progressively decreased with advancing cervical dilation. No consistent trend was found using the soft models. The respective results for correct effacement measurements were 49% soft versus 58% hard. Conclusions Assessment of cervical dilation and effacement was consistently more accurate in the hard, compared with the soft, cervical model. The greatest deviation between the models was noted among the residents, suggesting that beginning practitioners may benefit from learning on firm models before progressing to more realistic soft models. However, it should also be noted that all practitioners might benefit from practice with soft models, especially to determine accurate dilation because scores in this category were consistently below what might be expected.

Dear Editor, Please allow me to comment on the review article ‘Genetics of pelvic organ prolapse: crossing the bridge between bench and bedside in urogynecologic research’ by Bortolini and Rizk [1]. This paper is a comprehensive overview of molecular, biochemical and genetic research into the etiology of female pelvic organ prolapse. In this context the authors referee many dozens of inconclusive papers, all of which ignore pelvic floor trauma as an etiological factor in prolapse. It is therefore not surprising that the authors of this review state in their ‘Conclusions’ that ‘clearly, the most important causes of variations are still unknown’. The ‘most important causes’ are no longer unknown: quite on the contrary. We do know that pelvic floor trauma in childbirth is common [2–8] and strongly associated with prolapse [9] and prolapse recurrence [10–13]. Studies attempting to identify other risk factors for prolapse are unlikely to be successful unless they account for such an obvious confounder. In fact, one could argue that it is futile to investigate the genetics or biochemistry of prolapse in vaginally parous women— but that is precisely what everybody is doing, because 95% of our patients with prolapse symptoms are, of course, parous. I feel that a lot of time, money and resources could be saved by controlling for the confounding effect of pelvic floor trauma. All that is required is a digital vaginal examination.

This article questions the necessity for vaginal examinations in maternity care, looks at women's experiences of vaginal examinations, and discusses the importance of informed consent when such examinations are carried out.

A Corriedale ewe bred by a Corriedale ram was presented to our clinics with the history of preparturient prolapse. On examination, viscera were seen protruding from the vulva. The case was suspected to be a schistosoma reflexus which was later confirmed by vaginal examination. Due to wedging of the fetus in the pelvis and the narrow vaginal passage of the ewe, the monster lamb was recovered by Cesarean section. Photographs of monster lamb were taken before and after surgery.

The assessment of vaginal atrophy is central to menopause-related research and clinical practice. However, methods of grading vaginal atrophy have not been subjected to reliability and validity assessments.To assess the validity and reproducibility of selected vaginal examination findings proposed to represent vaginal atrophy and inflammation.Cross-sectional study.A convenience sample of 40 postmenopausal volunteers with past history of breast cancer.Participants completed questionnaires to assess vaginal symptoms. Pelvic examinations were carried out using specified criteria to assess the vaginal appearance. Vaginal cytological smears and pH measurements were performed using standardized techniques.A four-item physical examination atrophy scale had an alpha reliability of 0.48 and was statistically significantly correlated with pH (r = 0.55) and parabasal cells (r = 0.50). A three-item physical examination inflammation scale had an alpha reliability of 0.45. It was not significantly associated with vaginal smear-measured inflammation. Masked inter-rater agreement for the examination was 90%. Self-reported symptoms of itching/irritation or dryness were poorly related to findings on physical examination.These results offer objective validation that the physical characteristics proposed to represent atrophy are related to biomarkers of this condition. A relationship between examination characteristics believed to represent inflammation and inflammation biomarkers was not upheld.

Twenty-one days after they had calved, the vaginas of 34 cows were examined with a clean gloved hand, and 26 cows were left unexamined. Swabs were collected from the lumen of the uterine body of the cows on the same day and seven days later; bacteria were identified by aerobic and anaerobic culture, and bacterial growth was scored semi-quantitatively. On the same days, blood samples were collected and the concentrations of acute phase proteins were measured, and the diameters of the cows' uterine horns were measured by transrectal ultrasonography. The vaginal examinations did not result in uterine bacterial contamination or an acute phase protein response, and they did not affect the diameters of the uterine horns.

A 5-year-old Holstein-Friesian cow was presented with a primary problem of difficult in parturition (Dystocia). This was the third calving for the cow. A disoriented foetus was palpated per rectum, and on vaginal examination the head of the foetus was palpated which was ventral to the body of the foetus. A caesarotomy (caesarean section) was performed which aided in the diagnosis of a shistosomus reflexus. The shistosomus reflexus was examined grossly and the features observed were exposed abdominal organs, malformed skeleton, improperly positioned limbs which were adjacent to the head. Scoliosis (u shaped or curved spine) and this severe spinal inversion resulted in the head lying in close approximation to the sacrum.

Over a 2-year period 45 patients with bilateral paravaginal support defects underwent vaginal paravaginal repair. Postoperative evaluations were conducted and anatomic outcome was determined by vaginal examination, with grading of vaginal wall support. Functional outcome was assessed by a standardized quality of life questionnaire, voiding dairy and standing stress test with a full bladder. Thirty-five patients had long-term follow-up with a mean of 1.6 years (range 1-85). The recurrence rates for displacement cystocele, enterocele and rectocele were 3% (1/35), 20% (7/35) and 14% (5/35), respectively. In no patients did vault prolapse develop or recur. Subjective or objective evidence of persistent stress urinary incontinence was found in 57% of patients (12/21). Vaginal paravaginal repair is a safe and effective technique for the surgical correction of anterior vaginal wall prolapse but has limited applicability in the surgical correction of genuine stress incontinence.

We read this article with interest having conducted a similar study amongst 290 urology out-patients undergoing digital rectal and vaginal examinations. Our findings were comparable, concluding that patients should be offered a chaperone even if then declined. We also surveyed 47 doctors to discover doctors' attitude towards chaperones. Sinha et al. do not emphasise that the chaperone is for the protection of both patient and clinician. Thirty-two percent of patients in the study of Sinha et al. and 22% of patients in our study preferred the chaperone to be their spouse or relative whilst 60% of the doctors we surveyed preferred the chaperone not to be related to the patient. Guidance from the General Medical Council (GMC) suggests that ‘a relative or friend of the patient may be an acceptable chaperone’ contrary to the recommendations of the Ayling Inquiry that chaperones should not be friends or relatives of the patient.1,2 Significantly for medicolegal implications, we found that 74% of doctors did not document chaperone use. GMC guidance recommends that doctors ‘should record any discussion about chaperones and its outcome’, advice reiterated by the Medical Defence Union.1,3 We would like to emphasise that chaperones are for the protection of doctors as well as patients, and their use and documentation of it should be an integral part of the examination routine.