. The diagnosis and treatment of diseases of women. Fig. 92. Introducing the bivalve speculum. Firststep—^depressing the perineum to give room for thespeculum to be introduced. THE INFORMATION TO BE OBTAINED 81 Exposing Lower Portion of Vaginal Walls. To inspect the middle and lowerportions of the vaginal walls, turn the speculum so as to bring the various portionsof the walls opposite the opening between the blades. Another way is to inspectthe various portions of the walls just beyond the end of the speculum, as it iswithdrawn. Specula with skeleton blades are made, but they are not necessar
. The diagnosis and treatment of diseases of women. Fig. 92. Introducing the bivalve speculum. Firststep—^depressing the perineum to give room for thespeculum to be introduced. THE INFORMATION TO BE OBTAINED 81 Exposing Lower Portion of Vaginal Walls. To inspect the middle and lowerportions of the vaginal walls, turn the speculum so as to bring the various portionsof the walls opposite the opening between the blades. Another way is to inspectthe various portions of the walls just beyond the end of the speculum, as it iswithdrawn. Specula with skeleton blades are made, but they are not necessaryand ordinarily they are likely to prove unsatisfactory in a good many casesbecause of the prolapsing of the redundant vaginal walls through the Fig. 93. Introducing speculum. It lias been car- Fig. 94. Tlie speculum carried all the way in and ried part way in. Notice the oblique position, which turned into position for opening,prevents painful pressure on the urethra. Information Obtained in the Speculum Examination. The information sought in the speculum examination is obtained by inspectionof the following structures: Vaginal Walls—Color, Discharge, Redundancy; Cervix Uteri—Position, Color, Size and Shape, Lacerations, Deviation of Axis, Eversion, Erosion, Hypertrophy, Cystic Change, Ulcer;External Os—Size and Shape, Color of Edges, Discharge, Polypi. Vaginal Walls. Are the walls of normal color or is there congestion? If con-gestion, is it active or passive? If the walls are bright red, that means activeor arterial congestion and is due to inflammation or irritation. If the walls have abluish tinge, that means passive or venous congestion and indicates either preg- 82 THE PHYSICAL EXAMINATION nancy or some interferen
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