cyst detection

[simba20.livejournal.com]

A recent post got me thinking.......and a question popped into my head. Of course this question would be answered by those who have experienced this.

Quote from earlier post:
In a pelvic exam, the doctor examines your vulva, vagina, and (by using fingers to hold them still from inside your vagina, while pressing down gently on the belly) your uterus and ovaries.

While doing this part of the pelic exam, done with the fingers inside the vagina, and the hand pressing down on the tummy, would the doctor be able to detect cysts, endo, fibroids, or any other abnormality?

I've always wondered.

Also, everytime I have this part of the exam done, it hurts. Not to where there's a lot of pain, but it's a situation that is not just uncomfortable either. Does anyone else ever feel this way?

Thanks if anyone knows the answers. And for those that have experienced cysts, fibroids, or endo could you share how it was detected.

Comments

[katarokkar.livejournal.com]

DOn't know about your other questions, but it kidn of hurts for me too. Like you said, it's not sharp unbearable pain, but it's kind of as if I push down really hard on my stomach. I think that's normal because they are applying some pressure.

[shelleycoat.livejournal.com]

I get that same sensation, and despite the fact that I bring it to the doctors attention, we have yet to ever diagnose me with any fibroids, cysts, tipped uterus...nothin'. So if you figure it out, you let me know!

[appletrees.livejournal.com]

Hmm, odd, it's never felt uncomfortable for me. My doctor said that she was doing it to check for cysts or enlarged (?) areas.

[rusty-sunshine.livejournal.com]

I've never experienced pain in that part of the exam until this last summer, and we're still trying to figure out why I'm in pain...

My tipped uterus was discovered through a pelvic exam, and confirmed by ultrasound. I'm under the impression that generally, fibroids and cysts need to be diagnosed through ultrasound, and that endometriosis requires a laparascopy for diagnosis.

[simplyred.livejournal.com]

...There've been times when my pelvic exams have been painful for
me - but certainly not ~every~ time...which leads me to speculate
that the painful times might perhaps be related to, 'where I am in
my cycle', 'whether I might still be a bit sore from recent,
'overly enthusiastic' intercourse', or even, 'a yeast infection',
'If I either have a 'new' ovarian cyst - or an 'inflamed' older
one', or; if it may be related to, 'my retroverted uterus...which
may cause me additional sensitivity at certain times'...

...As for a GYN's ability to diagnose cysts, etc., based solely
upon a standard pelvic exam; my GYN has, on a few different
occasions, believed that she's, 'felt a cyst on my ovary', as well
as thinking that she, 'felt 2 small potential fibroids', within my
uterus... Following -EACH- of those experiences, her immediate
'SOP' has been to send me for ultrasounds...'standard' one's,
initially, & when/if *those* have shown a negative; she then
orders the 'intravaginal ultrasounds'.

I have a high tendancy toward ovarian cysts, & - thus far - when
she has 'suspected cysts or fibroids' based upon an office exam;
the ultrasounds have ended up confirming her DX approximately 75%
of the time.

I hope that this helps a bit with your questions...Good Luck to
you!...:-)

(P.S. Just a well-intentioned 'suggestion' to you here...
Rather than possibly growing to 'dread' your yearly exam, due to
the pain that you experience; It might be helpful to *both* you,
and your Doc, if you tell him/her about the pain, & ask
what it could be attributed to...9 times out of 10, there seems
to be a relatively 'simple' explanation, & one that will perhaps
serve to alleviate any fears or concerns that are in the back of
your mind!...;-)

[simba20.livejournal.com]

Really, I have no dread at my yearly exam, just a bit of nervousness which goes away as the exam goes on. My FNP (who does most of the physical exams), is friendly and talks about a variety of things to get my mind of the exam while she's doing it. Then she saves the "press on the tummy" last, and I've forgotten all about the pain, until she does it. And while it is uncomfortable, it does hurt somewhat.

Anyway, my questions were mainly for trying to determine what caused my wacky periods for 9 years. I only went to the gyno (the first time three years ago) on a "as soon as possible" time slot 'cause I was crying on the phone "Make my period stop!!" to the receptionist (I was going on month two of flow). Before I ever went I was reseaching my symptoms online, and kinda feel like over the past three years that I really haven't been checked out throughly (so to speak) for any thing abnormal (cysts, endo, fibroids). I went on birth control (which made my periods regular), but I am still at a loss for what caused 9 years of torment (absent periods, periods lasting for months, mind boggling heavy periods, and horrible cramps). During my first exam (and subsequent exams) I have always had the pelvic (press on the tummy) done, but my FNP has never said she felt anything.

During this year's exam, she said I could have PCOS, but then shouldn't she feel cysts?

[grace-is-gone.livejournal.com]

I was just seen in a gynecological ER for ovarian cysts. The doctor couldn't feel anything on palpation; it took a vaginal ultrasound for anything to turn up. That's also how they confirmed my diagnosis of endometriosis for the second time -- the adhesions were visable on the ultrasound. Ordinarily, though, it takes a laparoscopy for an endometriosis diagnosis.

Hope this helps.

[of-wings.livejournal.com]

The 'pain' you feel with the two-finger/press exam is caused by a pelvic muscle that runs from behind the bellybutton and down. It has nerve endings reaching all over the place.

If you poke at your bellybutton, sometimes you can even feel the sensation in your toes.

[katlynel.livejournal.com]

It definitely can't detect endometriosis; you need a laparoscopy for that (at which point they also do surgery to fix it). It's not really going to detect cysts or fibroids unless they're really big.

[smallstar.livejournal.com]

Well, I don't have a lot of experience with this, but I can tell you about my one experience with performing a pelvic exam (I'm a medical student, and so far I've only had the one opportunity to practice).

To be honest, I was always pretty sceptical about the bimanual part of the pelvic exam, and figured the doctors were sort of faking it. :) But, as it turns out, you really can feel a woman's uterus between your hands when you're doing it. It's kind of subtle... I couldn't feel a really obvious *lump* or anything, it was more that when I pressed on her lower abdomen, I could sort of feel the cervix pressing back against my other fingers, which my brain was able to interpret as the existance of *something* between my two hands. The doctor teaching me said that if you don't feel anything between your hands, the uterus is probably retroverted (tilted backwards), and that seems to be how most people are diagnosed. If the uterus feels really big or lumpy or asymmetrical, that could indicate fibroids, but it's also entirely possible to have fibroid that's not big enough to be detected on bimanual exam.

The next part of the exam is when you feel on either side of the uterus. Theoretically you're feeling for the woman's ovaries/fallopian tubes, but the truth is that if everything is normal, you don't generally feel anything at all. If you do feel a lump or mass there, it's probably a cyst or tumour or something enlarged and abnormal. But again, it's entirely possible to have cysts on your ovaries that are too small to be detected.

Endometriosis definitely can't be detected on bimanual exam. Usually the doctor will have a strong suspicion based on the history (ie. the patient complains of a lot of pelvic pain that's associated with menstruation), and it can be diagnosed definitively by laparoscopic examination - using a camera to look around inside the pelvis for bits of endometrium that shouldn't be there.

Re. pain during the exam... I think some level of discomfort with this is pretty common. Where does it hurt for you - on your abdomen where they're pushing, or inside your vagina? If it's the inside part that hurts, your cervix could be sensitive to pressure. This is quite common, and is the reason why some women find certain positions during intercourse to be very uncomfortable - having something pushing or banging against their cervix hurts. If it's the outside part that hurts, it could be just that your tummy just doesn't like someone pushing hard into it, which is also pretty understandable. :) Also, your bladder is right there in front of your uterus, so if it's at all full, then pushing on it will hurt. I think it would be a good idea to let your FNP know (in advance, if you remember) that that part of the exam hurts, so she can try to be extra gentle. And if you don't remember until it's actually happening, it's okay to just say "Oooh, that kinda hurts" so she has some immediate feedback. :)

[submarine-bells.livejournal.com]

Endometriosis definitely can't be detected on bimanual exam.

Er, yes it can. In some cases, anyway. That's how mine was first spotted. I had a large (inch or two long) endometrioma behind my uterus that was most definitely palpable during a pelvic exam. Of course, I had to have laparoscopic surgery to definitively confirm that the growth was endometriosis (as opposed to anything else that might produce ping-pong-ball-sized growths in odd places), but it most assuredly was detected originally through a manual pelvic exam.

[smallstar.livejournal.com]

I stand corrected, thanks. Learn something new every day... :)

If you don't mind me asking, what was done about it?

[submarine-bells.livejournal.com]

A vast array of things.

First was the laparoscopy to definitively diagnose it as endometriosis, as I mentioned before. They did a bit of diathermy to reduce the size of it, and snipped a few adhesions and burned off other smaller endometriomas while they were in there, but the biggie was too large and inaccessable for them to be able to completely dissect it during that bout of surgery since that would have been a much more major process.

After that, I went on Synarel (a gonadotrophin-releasing-hormone agonist) for six months, with the intent of shutting down sex hormone production and thus causing the big lesion to shrink. The reason for doing this was to make the major surgery needed to remove it fully somewhat easier. I then had my big surgery, early last year, in which the big lesion was as fully removed as possible.

Not that it's fixed it totally, sadly. The joy of endometriosis is that often it just keeps coming back. Now it seems that I have a brand noo one growing on one of my uterine ligaments, close to the spot where the previous one was. Last time it was measured (a few months ago) it was already 1.5cms long; chances are there is going to be plenty more surgery in my future. My gyn is advising a full hysterectomy/oophorectomy as a long term "solution", but like me he is not eager to do so in any great hurry. So in the mean time, I guess I just have to wait and see what happens, and hope for the best. *sigh*

[the-lissa.livejournal.com]

They suspected endo, but they didn't detect endo and cysts until i had a transvaginal and abdominal ultrasound.