If you don’t have anatomy posters or plastic models in your exam room, a blood pressure cuff makes an impromptu uterus. Using the bulb as an ovary and the tubing as the salpinx, I can demonstrate the procedure for a postpartum tubal ligation. Spring 2006
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When taking a cervical biopsy, it might be helpful to have the patient give two big coughs. Take the bite on the second cough and the majority of patients will not feel the biopsy at all. The coughing distracts them and they don’t hear the sound! Spring 2006
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Ask your Organon Rep to keep you well stocked with samples of Nuva Ring and have your patients practice using the device in the exam room. If your patients are still uneasy about placing the ring inside the vagina, keep a box of super absorbency tampons with a plastic applicator in your office and have your patients discard the tampon and use the plastic applicator to insert the ring. Spring 2006
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When counseling your patients about IUDs, bring out your training kits and have your patients use the inserter on the practice models. Reluctance can quickly be overcome when patients realize firsthand how easy insertion can be! Spring 2006
....................................... Don’t be confused if you don’t see a vaginal contraceptive ring in place during a speculum exam, it readily slips into the vaginal forchette. To visualize it, slightly over expand the speculum and look into the space between the vagina and cervix. Winter 2005
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When performing a vulvar biopsy, try injecting the lesions with lidocaine and then “tent” the lesion with your fingers. You can easily snip the crest of the tent with biopsy forceps making it easier than trying to biopsy smooth or retracted skin. Summer 2004
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Here is a list of useful programs that you can download or buy on the web. Check it out.
Summer 2004
....................................... These are excellent sources for patient education and include almost everything from contraception to STDs to piercing. I found an excellent patient education piece in PDF format on molluscum contagiosum. They are easy to print and free. www.youngwomenshealth.org is sponsored by the Boston Children’s Hospital and www.teenwire.org is a Planned Parenthood site. Both have information that is also applicable to “older” patients. Autumn 2003
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When performing cervical cryotherapy, it is important to protect the lateral walls of the vagina from the freezing effects of the cyroprobe.
Procedure:
- Insert and position the speculum to visualize the cervix
- Open the blades of the speculum wide enough so that the vaginal tissue does not touch the cervix, secure in place
- Insert a tongue blade into the vagina to compress the lateral wall. Repeat on the opposite side
- Insert and apply a well lubricated cryoprobe to the cervix
- Push each tongue blade into space on either side of the cervix and hold while treating the cervix
- Remove and discard tongue blades after cryoprobe is removed
Spring 2003
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I became frustrated when I began working with my current gynecologist because he could always dilate a cervix when I failed. I finally realized that his exam rooms were equipped with a different set of dilators than the ones in my rooms. I had brand X (which he had previously abandoned) and he used Pratt and Hank dilators. Both of these types have a more gradual size graduation from the apex to the base of the dilator. Typically I’m using only the smallest set of dilators as I’m usually preparing for an endometrial biopsy with a Pipelle. The smallest Pratt dilator is a 9/10 (French calibration signifies circumference) and the smallest Hank dilator is a 4.5 (diameter). Complete sets of the dilators become fairly expensive, so we’ve just stocked each of our rooms with individually wrapped dilators of the smaller size. Autumn 2002
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