| Objective
The objective of the visual inspection is solely to be able to
recognize clinically normal from abnormal cervix and refer abnormal
looking cases for further evaluation and diagnosis and appropriate
treatment.
The aim is to detect cervical cancer at an early stage in
asymptomatic women, to improve their prognosis. It can also be used to
selectively screen women who would require a Pap-smear, where that
facility is available, albeit in limitation.
Equipment required
- Examination table, preferrably with stirrups
- Sterile speculum, preferably Cusco's
- Sterile rubber gloves
- Source of light, a lamp or a torch
- Cotton swabs
- Forceps
- Stationary, to record examination findings
The Examination
- The procedure and the reason for it should be carefully
explained to the woman to be examined and she should be made as
comfortable as possible. Take into consideration the privacy of the
patient.
- Put patient in lithotomy position (if possible) or suppine with
legs bent at knees
- Good visualization is essential. Direct the light source to the
genital area.
- Observe and record any abnormal findings in the external
genitalia.
- Lubricate the speculum with warm water and insert into the
vagina with the speculum closed.
- Open the speculum and adjust the light source so as to get a
clear view of the cervix.
- If there is excess mucus or discharge, clean it with a cotton
swab soaked in boiled water or normal saline solution.
Important: Do not perform the examination if the woman is having
menstrual period or is using intravaginal medication. Advise her to come
back when the mensus or the treatment is over.
Reporting Visual Inspection Findings
The gross appearance of the cervix should be classified as follows:
|
Classification
|
Appearance of the Cervix (see
Atlas)
|
|
Normal |
|
|
Abnormal
Clinical interpretation:
Can be;
|
- Hypertrophy
- Redness or congestion
- Irregular surface
- Distortion
- Simple erosions (do not bleed on touch)
-
Cervical polyps (with smooth surface)
- Abnormal discharge: foul smelling, dirty/greenish,
cheesy white, blood stained
-
Nabothian follicles
- Prolapsed uterus
|
|
Suspicious
of Malignancy |
- Erosion that bleeds on touch or friable
- Growth, with an irregular surface or friable
|
Important: All findings, normal or abnormal, should be carefully
recorded in the provided printed form. The patient should be informed
and explained the follow-up procedure accordingly.
Referral Protocol
- Normal cervix: follow-up after 2-3 years according to the
decided policy. Advise to come back if develops symptoms.
- Abnormal cervix: (no suspicion of malignancy):
If infection is suspected, take a swab and send for analysis. Refer
the patient to the primary health clinic (PHC) for further
evaluation and treatment.At the PHC:
- If signs of infection are present, treat the patient
accordingly. Re-examine after six weeks.
- If no signs of infection. Perform Pap-smear and send for
analysis. Follow-up cytology results in 1-2 weeks and inform
patient accordingly.
- Pap-smear negative: re call after 2-3 years for visual
inspection
- Pap-smear positive: call the patient for appropriate
treatment.
- Suspicious of Malignancy: Refer directly to oncology/tertiary
care facility for appropriate assessment and treatment. Do not
perform Pap-smear.
Visual Examination Reporting Form
See Annex.
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