Is the cervix normal with no lesions and no cervical motion tenderness, with a chaperone present and blood noted, as documented by the Certified Medical Assistant (CMA)?

From the Guidelines

The patient's cervical examination findings of a normal cervix without visible lesions and no cervical motion tenderness are reassuring, but the presence of blood noted during the examination warrants further investigation to determine the source and cause of the bleeding. The presence of a chaperone in the room and documentation of the findings by the CMA are important for ensuring patient comfort and providing medicolegal protection 1. According to the American Academy of Pediatrics, a speculum examination should be performed to visualize the cervix and inspect for discharge and lesions, and samples can be obtained for laboratory and office-based analysis to diagnose conditions such as yeast infection, bacterial vaginosis, or trichomoniasis 1.

Some possible causes of the bleeding include normal menstrual bleeding, post-coital bleeding, or other conditions that may require further evaluation. Additional testing may be warranted, including:

• A Pap smear if not recently done
• STI testing
• Possibly colposcopy depending on the patient's history and risk factors The patient's history and risk factors should be taken into account when determining the need for further testing and evaluation. If the bleeding is persistent or concerning, follow-up with gynecology would be recommended to determine the exact cause and appropriate treatment. It is also important to note that the wet mount can miss trichomoniasis 30% to 50% of the time, and culture, nucleic acid probe, or antigen-based rapid testing may be more sensitive in detecting this infection 1.

The key points to consider in this patient's case are:

• The normal appearance of the cervix and absence of cervical motion tenderness
• The presence of blood noted during the examination
• The need for further investigation to determine the source and cause of the bleeding
• The importance of considering the patient's history and risk factors when determining the need for further testing and evaluation.

From the Research

Clinical Findings

• The patient has a cervix without lesions, and no cervical motion tenderness, which suggests that there is no significant inflammation or infection in the cervix 2.
• The presence of a chaperone in the room and a CMA document with blood noted may indicate that the patient has undergone a medical examination or procedure, possibly related to a gynecological issue.

Possible Diagnoses

• Cervicitis is unlikely given the absence of lesions and cervical motion tenderness, although it is usually asymptomatic and can cause complications of the upper genital tract 2.
• Uterine cervical lesions, including benign and malignant lesions, may not be present in this case since the cervix is described as being without lesions 3.
• Cervical ectopic pregnancy is a rare condition that may present with vaginal bleeding or pelvic pain, but it is not directly related to the absence of lesions or cervical motion tenderness 4.
• Cervical intraepithelial neoplasia (CIN) and cervical cancer are possible diagnoses during pregnancy, but they would typically be associated with abnormal cervical cytology results or suspicious lesions 5.

Management and Treatment

• The management of cervical lesions or other gynecological conditions would depend on the specific diagnosis and the patient's individual circumstances, including her medical history, pregnancy status, and other factors 5, 6.
• Transvaginal ultrasound-guided treatment of cervical pregnancy is a possible approach for managing ectopic pregnancies, but it is not relevant to this case since there is no indication of a cervical pregnancy 6.