Pathognomonic Signs and Metaphors of the Gynecologic Exam

June 25, 2014

By Damiana Andonova

Here we share memorable metaphors and pathognomonic signs, some of which are fruit and cheese metaphors in their own right. This is not mean to be an exhaustive list, but rather a reminder of the many interesting observations that can be made during a physical exam.

We begin with the peau d’orange appearance of breast cancer; the cervical petechiae that resemble the strawberry cervix of Trichomoniasis and the rather cottage cheese-like discharge of Candidiasis.

During a properly performed examination, a physician could further note cervical motion tenderness for pelvic peritonitis or perhaps pelvic inflammatory disease (PID). Of particular interest is the “Chandelier sign”, as the gynecologic patient would jump up and cling to the chandelier in utter pain.

Uterine size measured during a pelvic exam can also be likened to fruits: the non-pregnant or five weeks pregnant small pear, the three-month grapefruit (Margulies & Miller 2001).

Additionally, the physician could observe the esoteric grainy, sandy patches of schistosomiasis (of which S. haematobium is the etiological agent), the sulfur granules associated with pelvic actinomycosis, or utero-sacral nodularity, which is pathognomonic for endometriosis.

If a recto-vaginal exam is indicated and performed, a descending soft mass observed between the vaginal and rectal finger upon the Valsalva maneuver is pathognomonic for a rectocele. Similarly, the descent of a soft mass in the anterior vagina during the Valsalva maneuver noted in the bimanual portion of the pelvic exam can also be pathognomonic for a cystocele.

On the matter of observing discharge, some argue the color and consistency are pathognomonic for certain infections, including a frothy discharge for trichomoniasis and a thin fishy gray discharge associated with bacterial vaginosis.

Medical phraseology and the common every day language that can sometimes take over conversation can be fun to explore. And yet, while pathognomonic signs and metaphors can be fun to think about, they can also help us remember how useful the physical exam can be in the clinical encounter!

Can you think of more? Let us know!

Special thanks to Emmet Hirsch (Clinical Professor of Obstetrics and Gynecology at the Pritzker School of Medicine of the University of Chicago) and Paula Hillard (Professor of Obstetrics and Gynecology and Associate Char for Medical Student Education at Stanford University) for helping me in creating this article.

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