Quick video on how to tell a Cystocele from a Rectocele originally made for the Lay Public and the Non-Gynecologist. Cosmetic Gynecologist should definitely know this stuff.
I just realized there are lots of Primary Care docs and even core OBGYNS who may not have been introduced to the concept of the Half Speculum Exam. It is typically a Urogyn Specialty thing. So here is a quickie tutorial for those who may wonder what it is. I show this video to my pelvic prolapse patients and have it on my website so that the brave can choose to try and diagnose what they have before they see me. On my virtual Zoom Consults I even lead the patient to the website and play it for them. It is a great tool. Enjoy the minute video.
I released this same video on June 16, 2024, for the Lay Public, on my Feminine Wellness Newsletter and called it “What is that Bulge?” Subscribe and share that newsletter as an educational tool for your patients. I won’t mind at all.
Can you tell what this is? Bladder or Rectum or both? Tough to tell unless you do a lot to these types of evaluations and surgeries. I have been fooled myself when I went strictly by look and feel and used a standard bivalve speculum.
On the left side are the Before pictures. On the right side are the After pictures. Notice the speculum used in the bottom row? That is called a Half Speculum Exam. It isolates the bulge. I use the bottom half of a standard speculum or the one I designed called the Alinsod O-Shot Speculum.
Let me show you the steps on how I do the exams using a Half Speculum (the bottom of a standard speculum).
When the patient bears down a large spongy mass comes out. What is it? She lacks confidence in her appearance and thinks it is not sexy nor attractive. She wants the bulges repaired and to look like she did before babies. But she does not know what is coming out when she pushes or coughs.
She pushes and this round mass comes out. Like a baby’s head! Can you see a small slit across the very tip of the bulge? It is a giveaway that it is the cervix hanging out with the uterus behind it. Let’s confirm it.
I put a Half Speculum on the floor of the vagina to cover the rectum to prevent it from poking out and confusing me. That isolates the bladder and prevents the rectum from bulging out. Can you see the slit across the cervix? Huge hint that this is probably a uterovaginal vault prolapse with a significant cystocele.
I put a Half Speculum on the roof of the vagina to cover the bladder and prevent it from coming out. That isolates the rectum below and gives me a separate view of the posterior compartment alone. No cervix here.
About to start surgery in the operating room with the patient asleep. My Lone Star Retractor is placed, a catheter is in the bladder, and at rest you can see the wavy reggae of the vaginal wall covering the bladder. She actaully had no stress incontinence and decent midurethral support.
During surgery I have dissected the bladder off the vaginal mucosa, placed sutures on the Sacrospinous Ligament, attached them to a shaped dermal allograft, and completely covered the bladder. I put sutures on the Obturator ligaments bilaterally and use those to suspend the dermis distally.
Immediately After Surgery. I have the catheter in place for a few days, the vaginal packing will be removed in a few minutes. You can see the sutures used to repair the vaginal opening and giving her the eventual look of never having had a baby. She gets her virginal look back. The entire vaginal canal has also had a vaginoplasty to reduce the cavernous cavity.
Six weeks after surgery and she is healing quite well!
The Bulges are gone. The Vaginoplasty and Perineoplasty also done give her that beautiful youthful appearance and function.
That same Half Speculum exam shows that the Bladder bulge is gone!
That modest rectal Bulge is also gone and the floor if now firm and able to create friction during sex. The spongy waterbed-like floor has been repaired!
She is now 2 Fingers tight across.
The tightness and reduction in the diameter is full-length and not just the opening. She has friction from the entry to the top.
Here is a picture of my Alinsod O-Shot Speculum I use for my Half Spec Exams and O-Shots. The wings keep the labia out of the way and you get a terrific view of the insides.
If you are surgically inclined you may enjoy my Labiaplasty Newsletter for Medical Professionals so do check it out. I give it free to Gynflix Gold Fellows members.
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DALLAS OFFICE Alinsod Institute Dallas Women’s Wellness Institute of Dallas Preston Sherry Plaza 8201 Preston Road Suite 520 Dallas TX 75225 Phone: 945-900-7576 Contact: Dr. Red Alinsod: red@gynflix.com
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The Half Speculum Exam