Dyspareunia physical examination: Difference between revisions

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{{Dyspareunia}}
{{Dyspareunia}}
==Overview==
==Overview==
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
The presence of [[erythema]], [[discharge]], [[atrophy]] or [[ulceration]], [[growth]], [[deformity]], or [[warts]] on external genitalia or lesions on the [[cervix]] and [[internal genitalia]] can be suggestive of  [[dyspareunia]]. The presence of pain on the [[cotton-swab test]] is diagnostic of localized provoked [[vulvodynia]].


OR
Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
The presence of [finding(s)] on physical examination is diagnostic of [disease name].
OR
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
==Physical examination==
==Physical examination==
Physical examination of patients with [disease name] is usually normal.
The presence of [[erythema]], [[discharge]], [[atrophy]] or [[ulceration]], [[growth]], [[deformity]], or [[warts]] on external genitalia or lesions on the [[cervix]] and [[internal genitalia]] can be suggestive of [[dyspareunia]]. The presence of pain on the [[cotton-swab test]] is diagnostic of localized provoked [[vulvodynia]].
 
OR
 
Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
 
OR
 
The presence of [finding(s)] on physical examination is diagnostic of [disease name].
 
OR
 
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
 
===Appearance of the Patient===
===Appearance of the Patient===
*Patients with [disease name] usually appear [general appearance].  
*Patients with dyspareunia usually appear normal.  
 
===Vital Signs===
===Vital Signs===
 
*Vital signs usually normal
*High-grade / low-grade fever
*[[Hypothermia]] / hyperthermia may be present
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
*Tachypnea / bradypnea
*Kussmal respirations may be present in _____ (advanced disease state)
*Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
*High/low blood pressure with normal pulse pressure / [[wide pulse pressure]] / [[narrow pulse pressure]]


===Skin===
===Skin===
* Skin examination of patients with [disease name] is usually normal.
* Skin examination of patients with [[dyspareunia]] is usually normal.
OR
*[[Cyanosis]]
*[[Jaundice]]
* [[Pallor]]
* Bruises
 
<gallery widths="150px">
 
UploadedImage-01.jpg | Description {{dermref}}
UploadedImage-02.jpg | Description {{dermref}}
 
</gallery>


===HEENT===
===HEENT===
* HEENT examination of patients with [disease name] is usually normal.
* HEENT examination of patients with [[dyspareunia]] is usually normal.
OR
* Abnormalities of the head/hair may include ___
* Evidence of trauma
* Icteric sclera
* [[Nystagmus]]  
* Extra-ocular movements may be abnormal
*Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation
*Ophthalmoscopic exam may be abnormal with findings of ___
* Hearing acuity may be reduced
*[[Weber test]] may be abnormal (Note: A positive Weber test is considered a normal finding / A negative Weber test is considered an abnormal finding. To avoid confusion, you may write "abnormal Weber test".)
*[[Rinne test]] may be positive (Note: A positive Rinne test is considered a normal finding / A negative Rinne test is considered an abnormal finding. To avoid confusion, you may write "abnormal Rinne test".)
* [[Exudate]] from the ear canal
* Tenderness upon palpation of the ear pinnae/tragus (anterior to ear canal)
*Inflamed nares / congested nares
* [[Purulent]] exudate from the nares
* Facial tenderness
* Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae


===Neck===
===Neck===
* Neck examination of patients with [disease name] is usually normal.
* Neck examination of patients with [[dyspareunia]] is usually normal.
OR
*[[Jugular venous distension]]
*[[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
*[[Lymphadenopathy]] (describe location, size, tenderness, mobility, and symmetry)
*[[Thyromegaly]] / thyroid nodules
*[[Hepatojugular reflux]]


===Lungs===
===Lungs===
* Pulmonary examination of patients with [disease name] is usually normal.
* Pulmonary examination of patients with [[dyspareunia]] is usually normal.
OR
* Asymmetric chest expansion OR decreased chest expansion
*Lungs are hyporesonant OR hyperresonant
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
*Rhonchi
*Vesicular breath sounds OR distant breath sounds
*Expiratory wheezing OR inspiratory wheezing with normal OR delayed expiratory phase
*[[Wheezing]] may be present
*[[Egophony]] present/absent
*[[Bronchophony]] present/absent
*Normal/reduced [[tactile fremitus]]


===Heart===
===Heart===
* Cardiovascular examination of patients with [disease name] is usually normal.
* Cardiovascular examination of patients with [[dyspareunia]] is usually normal.
OR
*Chest tenderness upon palpation
*PMI within 2 cm of the sternum  (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
*[[Heave]] / [[thrill]]
*[[Friction rub]]
*[[Heart sounds#First heart tone S1, the "lub"(components M1 and T1)|S1]]
*[[Heart sounds#Second heart tone S2 the "dub"(components A2 and P2)|S2]]
*[[Heart sounds#Third heart sound S3|S3]]
*[[Heart sounds#Fourth heart sound S4|S4]]
*[[Heart sounds#Summation Gallop|Gallops]]
*A high/low grade early/late [[systolic murmur]] / [[diastolic murmur]] best heard at the base/apex/(specific valve region) may be heard using the bell/diaphgram of the stethoscope


===Abdomen===
===Abdomen===
* Abdominal examination of patients with [disease name] is usually normal.
* Abdominal examination of patients with [[dyspareunia]] is usually normal unless the cause of dyspareunia is [[adenexal mass]], [[uterine fibroids]], [[Pelvic tumor|pelvic tumors]].
OR
*[[Abdominal distension]]
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
*[[Rebound tenderness]] (positive Blumberg sign)
*A palpable abdominal mass in the right/left upper/lower abdominal quadrant
*Guarding may be present
*[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
*Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test


===Back===
===Back===
* Back examination of patients with [disease name] is usually normal.
* Back examination of patients with normal is usually normal, but 22% of patients with [[chronic pelvic pain]] has musculoskeletal causes.
OR
*Point tenderness over __ vertebrae (e.g. L3-L4)
*Sacral edema
*Costovertebral angle tenderness bilaterally/unilaterally
*Buffalo hump
 
===Genitourinary===
*Erythema or edema, white patches, valvular scarring, ulcers on external genitalia
*Clear/(color), foul-smelling/odorless penile/vaginal discharge


===Neuromuscular===
===Neuromuscular===
* Neuromuscular examination of patients with [disease name] is usually normal.
* Neuromuscular examination of patients with [[dyspareunia]] is usually normal, 22% of patients with [[chronic pelvic pain]] has musculoskeletal causes.
OR
*Patient is usually oriented to persons, place, and time
* Altered mental status
* Glasgow coma scale is ___ / 15
* Clonus may be present
* Hyperreflexia / hyporeflexia / areflexia
* Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
* Muscle rigidity
* Proximal/distal muscle weakness unilaterally/bilaterally
* ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
*Unilateral/bilateral upper/lower extremity weakness
*Unilateral/bilateral sensory loss in the upper/lower extremity
*Positive straight leg raise test
*Abnormal gait (describe gait: e.g. ataxic (cerebellar) gait / steppage gait / waddling gait / choeiform gait / Parkinsonian gait / sensory gait)
*Positive/negative Trendelenburg sign
*Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
*Normal finger-to-nose test / Dysmetria
*Absent/present dysdiadochokinesia (palm tapping test)


===Extremities===
===Extremities===
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===Genitourinary===
===Genitourinary===
Different findings can be found based on the underlying cause of dyspareunia.
Different findings can be found based on the underlying cause of [[dyspareunia]].
*Inflamed mucosa or Clear/(color), foul-smelling/odorless penile/vaginal discharge
*Inflamed mucosa or Clear/(color), foul-smelling/odorless [[penile]]/[[vaginal discharge]], [[atrophy]]
*A pelvic/adnexal mass may be palpated in pelvic tumors.
*A pelvic/adnexal mass may be palpated in [[pelvic tumor|pelvic tumors]].
*enlarged prostate in the rectal exam
*enlarged [[prostate]] in the [[rectal exam]]


==References==
==References==

Latest revision as of 00:16, 23 September 2020

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Overview

The presence of erythema, discharge, atrophy or ulceration, growth, deformity, or warts on external genitalia or lesions on the cervix and internal genitalia can be suggestive of dyspareunia. The presence of pain on the cotton-swab test is diagnostic of localized provoked vulvodynia.

Physical examination

The presence of erythema, discharge, atrophy or ulceration, growth, deformity, or warts on external genitalia or lesions on the cervix and internal genitalia can be suggestive of dyspareunia. The presence of pain on the cotton-swab test is diagnostic of localized provoked vulvodynia.

Appearance of the Patient

  • Patients with dyspareunia usually appear normal.

Vital Signs

  • Vital signs usually normal

Skin

  • Skin examination of patients with dyspareunia is usually normal.

HEENT

  • HEENT examination of patients with dyspareunia is usually normal.

Neck

  • Neck examination of patients with dyspareunia is usually normal.

Lungs

  • Pulmonary examination of patients with dyspareunia is usually normal.

Heart

  • Cardiovascular examination of patients with dyspareunia is usually normal.

Abdomen

Back

  • Back examination of patients with normal is usually normal, but 22% of patients with chronic pelvic pain has musculoskeletal causes.

Neuromuscular

Extremities

  • Extremities examination of patients with dyspareunia is usually normal.

Genitourinary

Different findings can be found based on the underlying cause of dyspareunia.

References

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