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Examination of the external genitalia. Action algorithm

Vaginal (internal) examination is performed with the middle and index fingers of one hand (usually the right). With the other hand, you must first separate the labia. A vaginal examination allows you to determine the condition of the pelvic floor muscles, large glands of the vestibule, urethra, vagina (volume, distensibility, soreness, the presence of pathological processes, condition of the vaults), the vaginal part of the cervix (position, size, shape, consistency, surface, mobility, soreness, condition of the external pharynx).

Subsequently, the examination is continued with both hands (inserted into the vagina and the other hand through the anterior abdominal wall).

Two-manual vaginal (bimanual, combined, vaginal-abdominal) examination is the main method for recognizing diseases of the uterus, appendages, pelvic peritoneum and tissue. When examining the uterus, its position (inclination, bend, etc.), size, shape, consistency, mobility, and pain are determined. Moving the outer hand to the side walls of the pelvis (alternately), and the inner hand to the lateral vaults of the vagina, the uterine appendages are examined. Unchanged fallopian tubes and ovaries are usually not palpable.

Using the second hand from the side of the abdominal wall, according to certain rules, palpation of the pelvic organs is carried out. In this case, it seems possible to establish the width of the entrance to the vagina, the condition of the perineum, the pelvic floor muscles, the length of the vagina, the depth of the vaginal vaults, the length and condition of the vaginal part of the cervix, the body of the uterus (position, size, consistency, mobility, pain, shape, etc.) and appendages (fallopian tubes and ovaries). This study can also provide insight into the condition of the pelvic walls (bone exostoses).

To obtain the most complete information, you must follow a certain sequence. Diseases of the urethra are excluded, its condition is determined (thickened, compacted, painful). The capacity of the vagina, the severity of folding of the mucous membrane, and the condition of its walls are assessed.

The next stage is examination of the vaginal part of the cervix. Its normal size is approximately the nail phalanx of the thumb.

In women who have given birth, the cervix of the uterus is cylindrical, while in nulliparous women it is cone-shaped. The consistency of the cervical tissue is dense. The condition of the external pharynx (normally closed) is essential.

After this, the uterus is examined. Its shape, size, consistency, displacement, sensitivity during palpation and movement are determined.

An enlarged uterus may indicate pregnancy or a tumor. Different consistency and asymmetry of the uterus, combined with its enlargement, may be associated with a tumor process. Limitation of uterine mobility is most often caused by an inflammatory or adhesive process.

The next stage is establishing the condition of the uterine appendages. To do this, the examining fingers are alternately transferred to the lateral arches. Unchanged uterine appendages can be palpated in a thin woman and with good relaxation of the anterior abdominal wall.

If the appendages are palpated, pay attention to their size, shape, clarity of contours, nature of the surface, consistency, mobility and sensitivity.

In acute inflammatory diseases of the uterine appendages, internal examination is painful, the contours of palpable organs are unclear, and it is often not possible to palpate the uterus from the general inflammatory conglomerate. With chronic inflammation, the altered appendages are palpated more clearly, have less pain, and are located in adhesions that limit their movement.

Ovarian cysts are often unilateral, palpable as a clear round formation with a smooth surface, quite mobile and painless.

Ovarian cystomas are denser, sometimes uneven in consistency; tumor movement may be limited.

In advanced forms of ovarian cancer, massive immobile tumor conglomerates are detected in the pelvis. It is not possible to palpate the uterus.

Then they move on to the study of parametriums. Usually the tissues of the parametrium cannot be felt with the fingers. In inflammatory diseases of the genital organs, the fiber may appear swollen, sharply painful, and in some cases it thickens (after previous inflammation). It is necessary to assess the condition of the parametriums in case of malignant neoplasms, since metastasis in cervical cancer occurs along the lymphatic tract to the lymph nodes on the lateral walls of the pelvis. In this case, the fiber becomes denser, and the cervix is pulled upward or to one of the side walls of the pelvis.

Some changes can also be detected in the uterosacral ligaments (during chronic inflammatory processes with a predominance of cicatricial adhesive changes). The ligaments (behind the uterus) are palpated thickened, shortened, and sharply painful. Movements of the uterus, especially anteriorly, cause severe pain.

Rectal, rectal-abdominal and recto-vaginal examinations are performed according to indications (or as an additional examination) in virgins, with atresia or stenosis of the vagina, with (inflammatory or tumor processes in the reproductive system.

A rectal examination is performed with the 2nd finger of the right hand and several fingers of the left (rectoabdominal). It helps to visualize the condition of the cervix, paravaginal and pararectal tissue, and to establish changes in the rectum (narrowing, compression by a tumor, infiltration of the walls, etc.). This study is also used in patients who have not been sexually active (with preserved hymen). A rectovaginal examination is performed by inserting the 2nd finger into the vagina and the 3rd into the rectum. This combined study is advisable to use if pathological changes in the parametric tissue and in the rectal-uterine space are suspected.

During a gynecological examination, smears from the urethra, vagina and cervical cord are taken from all women for bacteriological examination. The material is applied to two glass slides, divided (from below) into three parts each - U (urethra), C (cervical canal) and V (vagina). Before taking smears, the urethra is lightly massaged (outward). The secretions are taken with a grooved probe, the tip of tweezers or, preferably, by light scraping with a special spoon (Volkmann) and applied to both slides (on part M"). To take further smears, speculums are inserted into the vagina. A smear from the cervical canal is taken in the same way as from the urethra. Discharge from the posterior vaginal fornix is usually taken with a spatula (tweezers, forceps). Smears are applied to the corresponding parts of the slides (C and V).

For cytological examination of all women initially examined by a gynecologist in an outpatient clinic or admitted to a hospital, impression smears and material from the cervical canal are taken from the surface of the cervix.

2. 1. Algorithm for examining the external genitalia.

Indications:

· Assessment of physical development.

Equipment:

· Gynecological chair.

· Individual diaper.

· Sterile gloves.

1. Explain to the woman about the need for this study.

2. Ask the woman to undress.

3. Clean the gynecological chair with a rag moistened with a 0.5% calcium hypochlorite solution and lay down a clean diaper.

4. Place the woman on the gynecological chair.

5. Perform hand hygiene:

6. Apply 3-5 ml of antiseptic to your hands (70% alcohol or thoroughly wash your hands with soap).

Wash your hands using the following technique:

Vigorous friction of palms – 10 seconds, repeat mechanically 5 times;

The right palm washes (disinfects) the back of the left hand with rubbing movements, then the left palm washes the right hand in the same way, repeat 5 times;

The left palm is located on the right hand; fingers intertwined, repeat 5 times;

Alternately rubbing the thumbs of one hand with the palms of the other (palms clenched), repeat 5 times;

Alternating friction of the palm of one hand with the closed fingers of the other hand, repeat 5 times;

7. Rinse your hands under running water, holding them so that your wrists and hands are below elbow level.

8. Close the tap (using a paper napkin).

9. Dry your hands with a paper towel.

If it is not possible to hygienically wash your hands with water, you can treat them with 3-5 ml of antiseptic (based on 70% alcohol), apply it to your hands and rub until dry (do not wipe your hands). It is important to observe the exposure time - hands must be wet from the antiseptic for at least 15 seconds.

10. Put on clean, sterile gloves:

· Remove rings and jewelry;

· Wash your hands in the necessary way (regular or hygienic

hand treatment);

· Open the top package of disposable gloves and remove the gloves in the inner package with tweezers;

· Use sterile tweezers to unscrew the upper edges of the standard package, in it the gloves lie with the palm surface up, and the edges of the gloves are turned outward in the form of cuffs;

· With the thumb and forefinger of your right hand, grab the inside edge of the left glove from the inside and carefully put it on your left hand;

· Place the fingers of the left hand (wearing a glove) under the lapel of the back surface of the right glove and put it on the right hand;

· Without changing the position of the fingers, unscrew the curved edge of the glove;

· Also unscrew the edge of the left glove;

· Keep your hands in sterile gloves bent at the elbow joints and raised forward at a level above the waist; Examine the external genitalia: pubis, type of hair growth, whether the labia majora and minora cover the genital opening.

11. With the first and second fingers of the left hand, spread the labia majora and sequentially inspect: the clitoris, urethra, vestibule of the vagina, ducts of the Bartholinian and paraurethral glands, posterior commissure and perineum.

12. With the first and second fingers of your right hand, in the lower third of the labia majora, first on the right, then on the left, palpate the Bartholin’s glands.

13. The inspection is completed. Ask the woman to get up and get dressed.

14. Removing gloves:

With the fingers of your gloved left hand, grab the surface of the edge of the right glove and remove it with an energetic movement, turning it inside out;

Place the thumb of the right hand (without a glove) inside the left glove and, grasping the inner surface, vigorously remove the glove from the left hand, turning it inside out;

Place used gloves in a safe disposal box (safe disposal box)

15. Wash your hands with soap and water

16. Record the inspection results in the primary documentation.

Carol Fleischman, M.D.

“...with the daughter of our great-grandmother Eva, with the female sex, - speaking more clearly for the understanding of Your Majesty, with a woman”
W. Shakespeare, Love's Labour's Lost, Act I

Vulva and perineum
Anatomical landmarks
Examination technique
Female hair type
Tanner's stages of puberty
Enlarged inguinal lymph nodes (differential diagnosis)
The appearance of the vulva is normal
White lesions on the vulva
Precancerous leukoplakias
Other malignant tumors of the vulva
Clitoral index
Bartholin glands and cysts
Skene's glands
Condylomas lata and acuminata
Genital warts
Simple genital herpes
Ulceration of the vulva
Hernia of the labia
Vagina
Anatomical landmarks
Examination technique
Colpocele
Cystocele
Rectocele
Chadwick's sign
Gartner's duct cyst
Cervix
Anatomical landmarks
Examination technique
Duplication of the cervix
Endocervical polyp
Pap smear
Goodell Sign
Body of the uterus
Anatomical landmarks
Examination technique
Retroversion and retroflexion
Hegar's sign
Uterine prolapse
Fundal height of the uterus
Leopold's techniques
Leiomyoma and fibroid
Ovaries
Anatomical landmarks
Examination technique
Ovarian mass
Rectumuterine recess (space of Douglas)
Anatomical landmarks
Examination technique

TRADITIONAL QUESTIONS AND ANSWERS

1. What is the importance of a pelvic examination?

A pelvic examination is a mandatory part of the physical examination of women. A well-trained physician can identify many normal and pathological conditions (including pregnancy) and test for some types of cancer. The diagnosis is made based on the results of a physical examination and several simple laboratory tests that do not require sophisticated equipment.

2. How to make the examination of the pelvic organs painless and comfortable for the patient?

The pelvic examination should not cause the patient any discomfort or embarrassment. The examination should not be accompanied by painful sensations, except in inevitable situations when the cause of pain on palpation is the pathological condition itself. To make the examination of the pelvic organs more convenient for the patient, it is necessary to adhere to several simple rules:

Ask the patient to empty her bladder before the examination.
Position her as comfortably as possible and in such a way that you maintain eye contact with her.
Place the sheet over the patient's abdomen and legs (if she does not object to this).
Before continuing the examination, tell the patient in detail what exactly awaits her.
Before the examination, ask the patient to breathe and relax the perineal muscles.

The importance of constant communication with the patient during the examination cannot be overestimated. Some clinicians offer the woman a small mirror so she can watch the examination. Reassure the patient that if she experiences any discomfort, the examination will be discontinued. This gives the woman a feeling of confidence and helps the examination.

3. In what cases should an accompanying person be present during the examination of the pelvic organs?

In general, a chaperone should be present if the examination is performed by a man, if the patient is a minor, if she insists on the presence of a chaperone, or at the discretion of the physician, if the patient is excessively afraid of the examination.

4. Under what circumstances is a pelvic examination difficult for a woman to tolerate?

Women experience fear of pelvic examinations for a variety of reasons. A woman undergoing such an examination for the first time may experience fear of an unknown procedure. If a woman has not had sexual intercourse, the small size of the vaginal opening makes it difficult to conduct an examination using speculum. In a woman after menopause, especially if she does not remain sexually active, the opening to the vagina may be small and atrophied. The clinician also needs to consider the possibility that the patient may have been a victim of sexual abuse as a child or adult. This must be clarified during a conversation with the patient, when she is dressed and sitting on a chair. It is unacceptable to try to collect anamnesis during the examination. A patient who has been sexually assaulted may experience a panic attack or temporary loss of control during the examination. Representatives of some cultures may have undergone certain types of “circumcision”, which leads to changes in the anatomical structure of the genital organs and makes examination difficult.

5. What methods help when conducting a complex examination of the pelvic organs?

Communication with the patient is an integral part of the examination. If the patient brings her knees together at the beginning of the examination, interrupt the examination and allow the woman to return to a sitting position with the sheet covering her thighs. Talk to her about factors that make the examination difficult. If the inspection is not urgent, reschedule it for another day. For women undergoing an examination for the first time, encourage them to practice inserting tampons or disposable speculums. Women after menopause with atrophy of the vaginal mucosa may be advised to use a vaginal cream containing estrogen a week before the next examination. The victim of sexual violence should be asked whether she is afraid of the examination and whether she would like to receive additional advice on the eve of the examination.

6. Who has the right to perform a pelvic examination after rape?

The examination of a sexual assault victim should only be performed by a professional with forensic experience. Improper documentation can prevent law enforcement from apprehending and convicting a rapist. Local authorities usually provide a qualified physician with a special evidence collection kit and appropriate documentation forms to record the history and physical examination. Rape victims should be given maximum moral support. They should not change clothes or bathe before being examined by a forensic physician, as this may result in the loss of valuable evidence (clothing fibers, hair, contents under fingernails, blood or other body fluids).

7. What is required to conduct an adequate pelvic examination?

Examination chair with replaceable mats and footrests.
Replaceable covers for foot rests (oven gloves can be used instead of covers).
Good light source (gooseneck lamp or fiber optic lamp).
Gloves for examination.
Plastic or metal mirrors, including Pederson, Graves, and baby mirrors.
Surgical lubricant.

Although most information can be obtained from a direct physical examination, diagnosis is usually completed by a few simple procedures, a Pap smear, cytology testing for inflammatory cells, atypical cells, and cervical dysplasia. To carry out these studies, the following support is required:

Slides for Pap smears and wet processing of the specimen.
Cytological fixative.
Small test tubes with a few drops of saline solution for wet processing of the drug.
Paper indicator for determining pH.
Cytological brush and wooden spatulas for taking a Pap smear.
Test tube for laboratory material for gonorrhea and chlamydia using DNA analysis.
Test card for determining occult blood in stool.

VULVA AND PERINEUM

The pelvic examination begins with examination of the external genitalia.

TRADITIONAL QUESTIONS AND ANSWERS

8. What is female hair type?

The female type of hair growth (in adult women) is characterized by hair growth in the form of a triangle on the pubic area. The male type of hair growth is characterized by hair growth in the form of a diamond, rising to the navel. Male-pattern hair growth in women can be a sign of virilization or a variant of the norm.

9. What are Tanner stages of puberty?

Tanner stages are a method of assessing puberty based on breast and pubic hair growth. This method is used mainly among children and adolescents, but also forms an important part of the evaluation of patients with primary amenorrhea.

Tanner's stages of puberty in girls

Reproduced with permission from:Polin R.A., Ditmar M.F.: Pediatric Secrets, 2nd ed. Philadelphia, Hanley & Belfus, 1997.

10. Between what diseases is differential diagnosis carried out when the inguinal lymph nodes are enlarged?

Inguinal adenopathy can result from infection of the genitals, lower extremities, or the lymph nodes themselves. It may indicate a primary neoplastic disease (lymphoma) or metastatic disease.

11. What is the normal structure of the vulva?

The vulva consists of several anatomical structures: the pubis, the labia minora and majora, the clitoris, the vestibule of the vagina, and the large glands of the vestibule of the vagina (Bartholin's).

12. What important physiological information can be obtained by examining the vulva?

The thickness and folding of the vulva and vagina, as well as the presence of mucus, indicate the degree of estrogenization of the urogenital tract.

13. What is the meaning of “white lesions” on the vulva?

These lesions can be benign, precancerous, or malignant. Benign and malignant "white lesions" often co-exist. Therefore, they must be assessed with great care.

14. What are benign “white lesions” of the vulva?

Benign “white lesions” of the vulva include vitiligo and inflammatory dermatitis (such as psoriasis).

15. What are precancerous “white lesions” on the vulva?

These are dystrophic areas of the vulva (leukoplakia), which are white lesions from which a malignant tumor can develop. Atrophy, dystrophy or sclerotic lichen occurs in women of all age groups, but most often after menopause. These are yellowish-blue papules or spots that eventually coalesce to form areas of atrophied, greyish, smooth and thin mucosa. Extensive lesions can lead to narrowing of the vaginal opening. Hyperplastic dystrophy may appear as similar gray-white plaques that are distinguished microscopically by epithelial hyperplasia or atypical cells. Perhaps vulvar dystrophy represents a transitional stage from a benign to a malignant process. Benign and malignant dystrophic lesions are often present simultaneously. Therefore, a biopsy is important.

16. What are malignant white lesions?

Malignant leukoplakias are represented by vulvar intraepithelial neoplasia and Bowen's disease.

17. What are other malignant tumors of the vulva?

Squamous cell carcinoma is one of the most common malignant tumors of the vulva. In terms of its significance, the second most common tumor of the external genitalia is malignant melanoma. The doctor and patient should be attentive to moles in the vulvar area. A woman should conduct regular self-examination of this area to look for moles. Other histologic variants include adenocarcipoma (Bartholin's gland carcinoma), basal cell carcinoma, and sarcoma.

18. What is the littoral index?

The clitoral index in adults is calculated by multiplying the vertical size of the clitoris by its horizontal size. Normal values range from 9-35 mm. Enlargement of the clitoris is usually a sign of virilization. A clitoral index in the range of 36-99 mm is regarded as borderline. An index exceeding 100 mm is considered an abnormal phenomenon, and in this case it is necessary to look for the source of androgenization.

19. What do the vulva and clitoris look like with congenital adrenal hyperplasia?

Congenital adrenal hyperplasia is a collective term meaning an inherited deficiency of any enzyme in the chain of glucocorticosteroid synthesis. The most common enzyme deficiencies are 21-hydroxylase and 11-hydroxylase. β -hydroxylase. Decreased hydrocortisone synthesis leads to increased secretion of adrenocorticotropic hormone (ACTH), which causes an increase in adrenal steroid levels and a secondary increase in androgen levels. The result is virilization of the female genitalia, which is usually detected at birth. Symptoms include clitoral hypertrophy and labial fusion. If left untreated, secondary sexual characteristics do not develop.

20. What is the normal location of Bartholin's glands?

Bartholin's glands are located deep in the lateral sections of the vulva, near the posterior commissure. Normally they are not palpable. Often there are cysts and abscesses of the Bartholin glands, which are palpably defined as a palpable, usually painful, enlargement of one or both labia majora.

21. What is the procedure for examining Bartholin’s glands?

Place your gloved index finger at the inner surface of the vaginal opening and your thumb at the outer surface. Palpate gently for enlarged glands or tenderness.

22. What is the differential diagnosis of space-occupying formations in the Bartholin gland?

This is a cyst, abscess or adenocarcinoma of the Bartholin gland.

23. Who was Bartolin?

Caspar Bartholin (1655-1738) was a Danish physician. His father is a famous anatomist who was the first to describe the lymphatic system of the intestine with drainage of lymph into the thoracic duct. Bartholin is famous not only for his description of the glands named after him (and their possible cystic degeneration), but also for the discovery of the sublingual glands and their ducts (which still bear his name). In the last years of his life, he left medicine, devoted himself to politics and became Attorney General and Minister of Finance of Denmark.

24. Where are Skene’s glands normally located?

Skene's glands (paraurethral glands) are located on each side of the urethra.

25. Who was Skin?

Alexander J. Skene (1838-1900) was born in Scotland. At the age of 18, he moved to Canada and then to New York, where he received his medical degree during the Civil War. During this war, he served in the army (even organizing a military field hospital service), and then returned to practical gynecology, becoming one of the founders of the American Gynecological Society. In 1880 he described (although not the first) the glands, subsequentlytions named after him. Before him, these glands had already been described by Rainer de Graaf in 1672, but this description was completely forgotten.

26. What are condylomas lata?

Condylomas lata, or flat warts, are signs of secondary syphilis.

27. What are genital warts?

Genital warts, or genital warts, are caused by the human wart virus (HIV).

28. What is the significance of genital warts?

Genital warts, or condylomas, are flesh-colored papules with cauliflower-shaped papillary growths. They are caused by HPV, which is involved in the pathogenesis of cervical cancer. More than 70 serotypes of HBV are known. Serotypes 16, 18, 45 and 56 are considered to have the highest malignant potential.

29. What are the characteristic signs of herpes simplex on the genitals?

Herpetic lesions usually appear as clusters of small (1 mm or less in diameter) fluid-filled blisters on an erythematous base. Bubbles may burst or merge.

30. What is the differential diagnosis of vulvar ulceration?

Painful ulceration may result from ruptured confluent lesions of herpes simplex, or capcroid. A single painless ulcer is suspicious for syphilis. A long-standing, painless ulceration may be vulvar carcinoma.

31. What is a labia hernia?

A labial hernia is a rare case of prolapse of a loop of intestine into the labia majora, similar to an inguinal hernia in men.

VAGINA

TRADITIONAL QUESTIONS AND ANSWERS

32. What is the method of vaginal examination?

The vagina can be examined using a speculum, gently pressing it on the back wall of the vagina and spreading the gutters. Inspection of the vaginal vault is made easier by using a transparent plastic speculum. To detect a cystocele or rectocele, ask the patient to push and watch for bulging of the anterior or posterior vaginal wall.

33. How do Pedersen and Graves mirrors differ from each other?

The Pedersen mirror is narrow with flat grooves. It is convenient for most patients and is best suited for examining nulliparous and postmenopausal women with a narrow, atrophied vaginal opening. The Graves mirror consists of biconcave grooves. It is wider than the Pedersen mirror. It is convenient to use in multiparous women or in cases where the Pedersen speculum is not sufficiently clear.move the vaginal wall to examine the cervix. Pedersen and Graves mirrors can be plastic or metal.

34. What can you say about the hymen?

The hymen may be missing even if a woman has never had sexual intercourse. Often, the remnants of the hymen appear as a posterior rim or ring of thickened tissue around the vaginal opening.

35. What is a closed hymen?

A closed hymen is a congenital pathology that often remains unrecognized until puberty, when symptoms of delayed menstruation appear. Upon examination, the hymen appears to be an intact membrane, which is protruded by accumulated fluid. If left untreated, hematometra (collection of blood in the uterine cavity) and hematosalpings (collection of blood in the fallopian tube) may develop.

36. What is a colpocele?

A colygocele is a protrusion of the vaginal mucosa.

37. What is a cystocele?

A cystocele is a protrusion of the anterior vaginal wall with part of the bladder.

38. How to identify a cystocele?

When examining and palpating the anterior vaginal wall, if you ask the patient to cough. Protrusion of the anterior vaginal wall during coughing is a sign of cystocele.

39. What is a rectocele?

A rectocele is a protrusion of the posterior wall of the vagina with part of the rectum.

40. What are the criteria for rectovaginal fistula?

The patient may report vaginal contamination with feces. A fistula can be palpated as an area of compaction in the posterior vaginal wall.

41. What is Chadwick's sign?

Chadwick's sign is a bluish-purple color of the vagina and cervix. This symptom appears after the seventh week of pregnancy. It can also occur with tumors in the pelvic cavity due to stagnation of blood in the mucosa. Chadwick's sign is most noticeable on the anterior vaginal wall.

42. Who is Chadwick?

James R. Chadwick (1844-1905) was an American gynecologist. He was born in Boston and studied at Harvard University. Upon graduation, Chadwick traveled extensively throughout Europe, becoming acquainted with the medical centers of Vienna, London, Paris and Berlin. He then returned to Boston, where he became one of the founders of the Boston Medical Library and president of the American Society of Gynecologists.

43. What is the characteristic appearance of the vagina resulting from prenatal exposure to diethylstilbestrol (DES)?

Approximately 90% of women who were exposed to DES in utero had evidence of vaginal adenomatosis (the presence of glandular columnar epithelium in the vagina). This condition is not precancerous, but vaginal adenocarcinoma cells may also be present against its background. Therefore, women with adenomyosis are advised to have regular clinical examinations and colposcopy. DES was used from 1938 to 1972.

44. What is a Gartner's canal cyst?

A Gartner's canal cyst is a benign tumor of the anterior or lateral wall of the vagina. This is a congenital formation caused by remnants of the Wolffian duct epithelium.

45. Who is Gartner?

Hermann T. Gartier (1785-1827) was a Danish surgeon. A native of the Caribbean island of St. Thomas (which was still part of Denmark at the time), Gaertner eventually came to Denmark, attended medical school in Copenhagen, and worked as a military surgeon for most of his life.

46. What is the normal pH value of the vagina?

Normally, vaginal secretion is an acidic environment with a pH less than 4.5.

47. What is the meaning of soreness of the vaginal vaults?

Tenderness in the left or right vaginal vault may indicate ipsilateral salpingitis. Pain in the right vault can occur with appendicitis.

CERVIX

TRADITIONAL REPRESENTATIONS

48. What is the best method for examining the cervix?

Directing the speculum posteriorly, insert it into the vagina in a closed state as deeply as possible. Carefully open the gutters. In most cases, the gutters will frame the cervix. In rare cases, the cervix is difficult to see due to uterine retroflexion or cervical displacement due to prolapse. If you encounter difficulties, it is preferable to first perform a bimanual examination with two gloved fingers moistened with water (other lubricants do not allow a Pap smear). Once you have determined the position of the cervix, the mirror can be directed in the desired direction.

49. What does the cervix look like normally?

In a nulliparous woman, the cervix is normally round, pink in color, with a centrally located external opening of the cervical canal. In a woman who has given birth, the external opening of the cervical canal is located horizontally and may resemble a “fish mouth”. The darker red columnar epithelium in the area of the external opening of the cervical canal is a normal variant. Small yellowish Naboth gland cysts may also be visualized.

50. What are the causes of cervical duplication?

The cause of doubling of the cervix and the uterus itself is a violation of the fusion of the Müllerian duct. Typically, there is a partial or complete vaginal septum. On physical examination, it often turns out that the two cervixes have different sizes and are located next to each other in the frontal plane.

51. What is a flat-cylindrical border?

The flat-cylindrical border is the junction of the outer pink mucosa of the ectocervix with the glandular endothelium of the endocervical canal. This border may or may not be visible when viewed with mirrors. For adequate testing, two types of cells must be present in Pap smears.

52. What is the significance of endocervical polyps?

Endocervical polyps are composed of glandular epithelium and appear as small pedunculated formations protruding from the cervical canal. Although these lesions may be friable and bleeding, they are always benign.

53. What is the best way to take a Pap smear?

Eidocervical canal cells are obtained by inserting a special brush into the endocervical canal and rotating it 360° around its axis. The brush is removed and either passed over a glass slide (standard method) or lowered into a test tube with medium (thin preparation method). The squamous epithelium of the ectocervix is scraped off with a wooden spatula and also distributed on glass or in a special medium. Slides containing Pap smears should be treated with cytological fixative as quickly as possible.

54. Which patients are indicated for a Pap test?

Sexually active women should have Paianikolaou smear tests annually or every two years because they are at risk of HIV infection. In women who have undergone hysterectomy for malignancy, it is recommended that subsequent Pap smear screening examinations be continued. Women who have had a hysterectomy for benign lesions (such as fibroids) do not need a Pap smear test.

55. Who is Papanicolaou?

George N. Papanicolaou (1883-1962) was an American pathologist. A native of Greece, he graduated from the University of Athens and received a medical degree, following the wishes of his father and with the condition that he could later study history and philosophy. The Balkan War of 1912-1913 and the outbreak of the First World War completely changed his plans. He decided to emigrate to the USA, where he headed the department of pathology at Cornell University.

56. What is the significance of purulent discharge from the cervix?

Purulent discharge from the cervix is a herald of purulent cervicitis, most often caused by gonorrhea or chlamydial infection. If left untreated, this can lead to pelvic inflammatory disease and serious complications.

57. What is the meaning of pain when the cervix moves?

Pain when the cervix moves is a sign of pelvic inflammatory disease. Informally, this sign is called the “chandelier sign,” meaning that the patient jumps towards the chandelier when the cervix is palpated.

58. What additional laboratory tests should be performed when examining the cervix?

In patients at high risk of sexually transmitted diseases, some clinicians are required to conduct a microbiological examination of material from the cervix for gonorrhea and chlamydia. In particular, chlamydial infection can be relatively asymptomatic. If left undiagnosed, it can lead to serious consequences (for example, infertility). Therefore, it is appropriate to expand the indications for microbiological research as much as possible, and if any of the above-mentioned signs of purulent cervicitis are present, it must be carried out without fail. The most convenient method for research is DNA analysis.

59. What is Goodell's sign?

Goodell's sign is a softening of the cervix during pregnancy and is usually detected from around 8 weeks. We can say that the cervix of a non-pregnant woman resembles the tip of the nose in density, while the softer cervix of a pregnant woman resembles a lip in tactile sensations.

60. Who is Goodell?

William Goodell (1829-1894) was an American gynecologist. He was born in Malta (where his missionary father lived at that time) and graduated from the Medical College. Jefferson in 1854. After 3 years of work in Constantinople (where he managed to get married), Goodell returned to the United States and headed the department of gynecology at the University of Pennsylvania. He was a wealthy man, but suffered from insomnia and gout all his life.

BODY OF THE UTERUS

TRADITIONAL REPRESENTATIONS

61. What is the normal shape and position of the uterus?

The uterus has the shape and size of a small pear. Approximately 80% of patients experience anteversion and anteflexion of the uterus. In 20% of women, retroversion of the uterus occurs, which is a variant of the norm and is not considered a pathology.

62. What is the technique for examining the uterus?

The uterus is assessed by bimanual examination. The doctor is in a standing position. The index and middle fingers of one gloved hand are inserted into the vagina with gentle pressure on the back wall and move towards the back fornix. With the other hand, the doctor palpates the uterus through the anterior abdominal section.

63. What are the differences between retroversion and retroflexion of the uterus? Retroversionrepresents a posterior deviation of the entire uterus, including

neck Retroflexion - this is a posterior deviation of only the body of the uterus, while the cervix remains in its normal position. Both conditions are considered normal and occur in 20% of women.

Rice. 17.1. A. Retroversion of the uterus. B. Retroflexion of the uterus. (Reproduced with permission from:Seidel N.M., Ball J.W., Danis J.E., Benedict G.W.: Mosby’s Guide to Physical Examination, 3rd ed. St. Louis, Mosby, 1995)

64. What is Hegar's sign?

Hegar's sign is a softening of the uterus in the area between the cervix and the fundus. It occurs during the first trimester of pregnancy. To locate it, insert two fingers into the posterior vaginal fornix, and then gently press on the uterus with your other hand.

65. What is uterine prolapse?

Uterine prolapse is a downward sagging of the uterus due to gravity. The cause of prolapse is weakness of the pelvic floor muscles. Atfirst degree prolapsethe uterus is descended, but is still palpable quite high in the vaginal vault. Atprolapse of the second degreethe uterus descends to the length of the vagina, and the cervix is located at the entrance to the vagina.Third degree prolapsealso calleduterine prolapse,is a prolapse of the uterus below the vaginal slit.

66. What is the height of the uterine fundus? How does it change with the duration of pregnancy?

Fundal height is the vertical dimension of the pregnant uterus. After 12 weeks of pregnancy, the fundus of the uterus can be palpated above the edge of the pubis. From 18 weeks it is palpable at the level of the navel.

67. What are Leopold's techniques?

Four methods of palpation of the abdomen of a pregnant woman but Leopold allow one to determine the position of the fetus after the twenty-eighth week of pregnancy.

68. What is leiomyomatosis?

Leiomyomas, also known as uterine fibroids or fibroids, are benign muscle tumors of the uterus. Their sizes vary from not detectable by palpation to very large. The size of leiomyomas is usually reported in weeks of pregnancy. For example, a fibroid uterus enlarged to 18 weeks is referred to as "18-week fibroid." Leiomyomatosis in the lateral parts of the uterus may be impossible to distinguish from formations in the ovaries. Large leiomyomas can be easily palpated in the lower abdomen.

69. Can fibroids become malignant?

Rarely. Leiomyosarcomas account for less than 1% of uterine tumors.

UTERINE APPENDAGES

TRADITIONAL QUESTIONS AND ANSWERS

70. What are the uterine appendages?

The epididymis consists of the ovaries, oviducts (fallopian tubes) and connective tissue.

71. What is the normal size of the ovary?

In young women, the largest size of the ovary is usually 3.5-4 cm. After menopause, the ovary decreases to 2 cm and is not palpable during examination.

72. How are the uterine appendages examined?

The adnexa are assessed during a bimanual examination after completion of the uterine examination. The doctor's fingers, located in the vagina, move from the posterior fornix in turn to the lateral fornix. At this time, the hand on the stomach slides medially and downward from the edge of the pelvis. This examination is difficult to perform in obese patients.

73. What is the differential diagnosis of space-occupying formations of the appendages?

Adnexal masses may be physiological cysts (follicular cyst or corpus luteum cyst), polycystic ovaries, ectopic pregnancy, endometrioma, benign tumors (eg, teratoma, serous or mucinous cystadenoma, Bren-Per tumor), malignant ovarian tumors, tubovarial abscess, hydrosalpinx or hematosalpiix. In some cases, formations palpated in the area of the appendages are not actually associated with them. Examples are myomatous nodes of the lateral parts of the uterus or nodes on the leg, appendiceal infiltrate or abscess, a kidney descending into the pelvis, or abdominal tumors.

74. What is the differential diagnosis of painful appendages?

It is necessary to exclude ectoid pregnancy and tubovarial abscess. Other causes include ovarian cysts, endometrioma, and intra-abdominal pathology (eg, appendicitis).

75. What are some physical characteristics of ovarian malignancies?

Malignant tumors are more likely to be bilateral, large, less mobile, nodular, and irregular to palpation. They may be accompanied by other physical findings (eg, abdominal distension and ascites).

76. What is the rectouterine recess?

The rectouterine recess, also known as the pouch of Douglas, is a space lined by parietal peritoneum posterior to the uterus.

77. What information can be obtained during a rectovaginal examination?

A rectovaginal examination examines the back of the uterus and the rectouterine cavity to identify possible tenderness and fluid.

LITERARY SOURCES

Bastian L.A., Piscitelli J.T.: Is the patient? Can you reliably rule in or out pregnancy by clinical examination? JAMA 278:586-591, 1997.
Bates B.: A Guide to Physical Examination and History Taking, 6th ed. Philadelphia, J.B. Lippincott, 1995.
Cotran R.S., Kumar V., Robbins S.L.: Robbins Pathologic Basis of Disease, 5th ed. Philadelphia, W.B. Saunders, 1994.
DeGowin R.L.: DeGowin and DeGowin’s Diagnostic Examination, 6th ed. New York, McGraw-Hill, 1994.
Fauci A.S., Braunwald E., Isselbacher K.J., et al (eds): Harrison’s Principles of Internal Medicine, 14th ed. New York, McGraw-Hill, 1998.
Frederickson H.L., Wilkins-Haug L. (eds): Ob/Gyn Secrets, 2nd ed. Philadelphia, Hanley & Belfus, 1997.
Mayeaux E.J., Spigener S.: Epidemiology of human papillomavirus infection. Hosp. Pract. 15: 39-41, 1997.
Moore K.L., Persaud T.V.N.: The Developing Human 6th ed. Philadelphia, W.B. Saunders, 1998.
Pearce K., et al: Cytopathological findings on vaginal Papanicolaou smears after hysterectomy for benign gynecological disease. N.Engl. J. Med. 335:1559-1562,1996.
Research Action and Information Network for Bodily Integrity of Women, 915 Broadway, Suite 1603, New York, NY 10010-7108.
Sapira J.: The Art and Science of Bedside Diagnosis. Baltimore, Urban & Schwartzenburg, 1990.
Wallis L.: Modern Breast and Pelvic Examinations. New York, National Council on Women's Health, 1996.

Modern methods of objective examination of gynecological patients include,

Examination methods in gynecology

Modern methods of objective examination of gynecological patients include, along with traditional ones, a number of new techniques that allow us to have the most complete understanding of the nature of the disease, the phase and extent of the pathological process

The examination of the patient begins with a survey, then proceeds to her examination, after which a plan for a laboratory examination of the patient is drawn up. After this, according to indications, instrumental examination methods and special diagnostic techniques can be used. Despite the fact that the schemes for examining gynecological patients are well known and described in textbooks and manuals, it makes sense to once again give an approximate plan and procedure for examining the patient, so as not to miss any significant point that is crucial in diagnosis.

The most complete and comprehensive examination can only be carried out by professionals. If you need one of the procedures described below, do not hesitate, contact the doctors of the medical center Your Clinic and receive a 10% discount!

Anamnesis

When collecting anamnesis, the age of the patient is of great importance. For example, in pre- and postmenopausal women, as well as in young girls who are not sexually active, pregnancy-related diseases can be immediately excluded. In addition to the main complaint, there are accompanying complaints, which the woman reports after additional, leading questions. Important information can be obtained by finding out your lifestyle, diet, and bad habits. When collecting anamnesis, it is necessary to be interested in the nature of the work and living conditions.

Taking into account the hereditary nature of many diseases, information should be obtained about mental illness, endocrine disorders (diabetes, hyper- or hypothyroidism, etc.), the presence of tumors (fibroids, cancer, etc.), and pathology of the cardiovascular system in relatives of the first and second generations. In addition to the usual questions regarding family history, in women with menstrual irregularities, infertility, excess hair growth, it is necessary to find out whether immediate relatives have obesity, hirsutism, or whether there have been cases of miscarriage.

Information about previous somatic diseases, their course, and surgical interventions is important for clarifying the nature of gynecological diseases. Particular attention is paid to infectious diseases.

For the recognition of gynecological diseases, data on menstrual, reproductive, secretory and sexual functions are of utmost importance.

Menstruation disorders most often occur when the functions of the nerve centers that regulate the activity of the endocrine glands are disrupted. The functional instability of this system can be congenital or acquired as a result of damaging factors (diseases, stressful situations, malnutrition, etc.) in childhood and during puberty.

It is necessary to find out how many pregnancies the patient had, how they proceeded and how they ended. Gynecological diseases can be both the cause of reproductive dysfunction (infertility, spontaneous abortions, abnormalities of labor, etc.) and their consequence (inflammation, neuroendocrine disorders, consequences of obstetric injuries). To recognize gynecological pathology, information about postpartum (post-abortion) diseases of infectious etiology is of great importance.

Pathological secretion (leucorrhoea) can be a manifestation of disease in different parts of the genital organs. There are tubal leucorrhoea (emptying hydrosalpinx), uterine leucorrhoea (endometritis, polyps), cervical leucorrhoea (endocervicitis, polyps, erosions).

The most common type is vaginal leucorrhoea. Normally, the processes of formation and resorption of vaginal contents are completely balanced, and the symptom of the appearance of leucorrhoea, as a rule, indicates an inflammatory process.

Data on sexual function deserve attention because its disorders are observed in a number of gynecological diseases. It is known that sexual feeling and sexual desire characterize the maturity of a woman’s sexual function. The absence of these indicators is observed in gonadal dysgenesis and other endocrine disorders, as well as a number of gynecological diseases.

After a correctly collected anamnesis, a diagnosis can be made in 50-60% of patients and the direction of further examination can be determined (the choice of diagnostic methods and the sequence of their use).

Assessment of general condition

The assessment of the general condition begins with an external examination. Pay attention to height and body weight, physique, development of adipose tissue, and features of its distribution. Particular attention is paid to the condition of the skin. It is necessary to pay attention to the color of the skin, the nature of hair growth, acne, increased porosity, etc.

It is necessary to examine the area of lymph nodes accessible to palpation. Measurement of blood pressure, pulse rate, listening to the lungs, percussion and palpation of the abdomen are carried out. The mammary glands are carefully examined, a visual examination is carried out in a standing position, then in a lying position, sequential palpation of the armpits, external and internal quadrants of the gland is carried out.

Gynecological examination

Gynecological examination involves carrying out a whole range of methods to study the state of the woman’s reproductive system. Research methods can be divided into basic ones, which are used to examine all patients without fail, and additional ones, which are used according to indications, depending on the intended diagnosis. This study is carried out on a gynecological chair after emptying the bladder and, preferably, after defecation. The study is carried out wearing sterile gloves.

Examination of the external genitalia.

Pay attention to the nature and degree of hair growth, the development of the labia minora and majora, and the gaping of the genital slit. During examination, the presence of inflammatory pathological processes, ulcers, tumors, varicose veins, and discharge from the vagina or rectum is noted. The woman is asked to push, while determining whether there is prolapse or prolapse of the walls of the vagina and uterus.

Inspection using a mirrorcal.

The examination is carried out before a vaginal bimanual (two-handed) examination, since the latter can change the picture of the pathological process. Casement or spoon-shaped mirrors are used. The folding speculum is carefully inserted in a closed state along the entire length of the vagina, after first spreading the labia minora with the left hand. If a spoon-shaped speculum is used, then an additional lift is inserted to lift the anterior wall of the vagina. Having exposed the cervix, they examine it, noting the color of the mucous membrane, the nature of the secretion, the shape of the cervix, the presence of ulcers, scars, polyps, tumors, fistulas, etc. After a visual examination, smears are taken for bacterioscopic and cytological examination.

Vaginal (bimanual) examination.

Carrying out this study provides valuable data on the condition of the internal genital organs. It must be carried out in compliance with all requirements of asepsis and antisepsis. During the examination, the fingers of the right hand should be in the vagina, and the left hand should be located on the anterior abdominal wall, palm down. The uterus is palpated sequentially, determining its position, displacement along the horizontal and vertical axis, consistency and size. Then the uterine appendages are palpated, for which the fingers of the right hand located in the vagina are moved to the left and then to the right fornix, and the outer hand is moved to the corresponding inguinal-iliac region. On palpation, the uterus has a pear-shaped shape, a smooth surface, easily moves in all directions, and is painless on palpation. Normally, tubes and ovaries are not identified; when determining formations in this area, it is necessary to identify them as inflammatory or tumor-like, which often requires additional or special research methods.

Vaginal examination data allows you to diagnose the presence of uterine tumors, fallopian tube formations and ovarian tumors. We must not forget that for correct diagnosis it is important not so much the presence of individual symptoms as their detection in combination with other signs of the disease.

After a survey, examination and two-manual gynecological examination, a preliminary diagnosis is established. This allows you to draw up a plan for further in-depth examination using laboratory diagnostics, instrumental examination methods and various diagnostic techniques. Establishing a preliminary diagnosis gives the right, along with ongoing examination, to begin drug treatment depending on the nosological form of the gynecological disease.

Bacterioscopic examination.

It is used to diagnose inflammatory diseases, and its results allow us to determine the type of pathogen. Bacterioscopy makes it possible to determine the degree of cleanliness of the vagina, which is necessary before any diagnostic procedures and gynecological operations. Material for bacterioscopic examination is taken with a Volkmann spoon from the urethra, cervical canal, and posterior vaginal fornix. Before the study, you should not treat the vaginal walls with disinfectants, douche or inject medications. It is better to take a smear before urinating. A smear is taken from the urethra using a Volkmann spoon with a narrow end or a grooved probe after preliminary massage of the urethra from back to front, pressing the urethra to the womb until a drop of discharge is obtained, which is applied to a glass slide with markings in a thin layer. A smear from the cervical canal is taken after exposing the cervix in the speculum using a Volkmann spoon with a wide end or a probe. Each smear is taken with a separate instrument, applied in a thin layer to two glass slides. According to the nature of the smear, there are four degrees of purity of vaginal contents:

I degree of purity. The smear reveals single leukocytes (no more than 5 in the field of view), vaginal bacilli (Dederlein bacilli) and squamous epithelium. The reaction is sour.

II degree of purity. In the smear, leukocytes are determined (no more than 10-15 in the field of view), along with Dederlein rods, single cocci and epithelial cells are determined. The reaction is sour.

III degree of purity. There are 30-40 leukocytes in the smear, vaginal bacilli are not detected, various cocci predominate. The reaction is slightly alkaline.

IV degree of purity. There are no vaginal bacilli, many pathogenic microbes, including specific ones - gonococci, trichomonas, etc. The reaction is alkaline.

I-II degrees of purity are considered the norm. All types of surgical and instrumental interventions in gynecology should be carried out in the presence of such smears. III and IV degrees of purity accompany the pathological process and require treatment.

Cytological examination.

Produced for early detection of cancer. Smears are taken from the surface of the cervix or from the cervical canal. Material obtained by puncture from space-occupying formations or aspirate from the uterine cavity is also subjected to cytological examination. The material is applied to a glass slide and air dried. Mass cytological examination carried out during preventive examinations makes it possible to identify a contingent of women (in whom atypical cells are detected) who need a more detailed examination to exclude or confirm cancer of the female genital organs.

Colposcopy.

The first endoscopic method that has found wide application in gynecological practice. The diagnostic value of the method is very high. This method provides the opportunity to examine the vulva, vaginal walls and the vaginal part of the cervix using a colposcope, which magnifies the object in question by 30-50 times. allows you to identify early forms of pre-tumor conditions, select a site for biopsy, and also monitor healing during the treatment process.

Simple colposcopy. Makes it possible to determine the shape, size of the cervix, external os, color, relief of the mucous membrane, the border of the squamous epithelium covering the cervix and the condition of the columnar epithelium.
Extended colposcopy. It differs from simple colposcopy in that before the examination the cervix is treated with a 3% solution of acetic acid, which causes short-term swelling of the epithelium and a decrease in blood supply. The action lasts 4 minutes. After studying the resulting colposcopic picture, a Schiller test is performed - smearing the cervix with a cotton swab with 3% Lugol's solution. The iodine contained in the solution colors glycogen in healthy epithelial cells dark brown. Pathologically altered cells in various dysplasias of the cervical epithelium are poor in glycogen and are not stained with iodine solution. Thus, areas of pathologically altered epithelium are identified and areas for cervical biopsy are designated.

Probing of the uterus.

The method is used for diagnostic purposes to determine the patency of the cervical canal, the length of the uterine cavity, its direction, the shape of the uterine cavity, the presence and location of submucous tumors of the uterus, bicornuity of the uterus or the presence of a septum in its cavity.

Curettage of the uterine cavity.

It is performed for diagnostic purposes to determine the cause of uterine bleeding, if malignant tumors of the uterus are suspected, as well as to collect histological material from the uterus according to indications.

Cervical biopsy.

It is a diagnostic method that allows for a timely diagnosis if there is a suspicion of a tumor process of the cervix.

Puncture through the posterior vaginal fornix.

This is a widespread and effective research method, with which you can confirm with a high degree of confidence the presence of intra-abdominal bleeding, as well as analyze the discharge obtained by puncture.

Ultrasound examination (ultrasound).

Ultrasound is a non-invasive research method and can be performed on almost any patient, regardless of her condition. The safety of the method has made it one of the main methods for monitoring the condition of the intrauterine fetus. In gynecological practice, it is used to diagnose diseases and tumors of the uterus, appendages, and to identify abnormalities in the development of the internal genital organs. Using ultrasound, you can monitor the growth of the follicle, diagnose ovulation, record the thickness of the endometrium, and detect its hyperplasia and polyps. The diagnostic capabilities of ultrasound have been significantly expanded after the introduction of vaginal sensors, which improves the diagnosis of retrocervical endometriosis, adenomyosis, inflammatory formations in the uterine appendages and various forms of the tumor process.

Hysteroscopy (HS).

The main advantage of the method is the ability to detect intrauterine pathology using the optical system of a hysteroscope. Gas and liquid hysteroscopy are used. With gas HS, the uterine cavity is examined in a gas environment (carbon dioxide). Liquid HS is most often used using various solutions, most often isotonic sodium chloride solution. The great advantage of this method is the ability to perform not only an examination of the uterine cavity, but also surgical manipulations with subsequent monitoring (diagnostic curettage, polypectomy, “unscrewing” of the myomatous node, separation of synechiae, etc.). Expansion of the cervical canal to № 8-9 Hegara dilators guarantee the free outflow of lavage fluid and prevent pieces of the endometrium from entering the abdominal cavity. Indications for hysteroscopy:

uterine bleeding in women of any age of a cyclic and acyclic nature;
control over the treatment of hyperplastic conditions;
suspicion of intrauterine synechiae;
suspicion of endometrial malformation;
multiple endometrial polyps, etc.

Hysterosalpingography (HSG).

HSG has long been used in gynecology to determine the patency of the fallopian tubes, detect anatomical changes in the uterine cavity, and adhesions in the pelvic cavity. HSG is performed in an X-ray operating room. The study is performed with aqueous, contrast agents (Verografin - 76%, Urografin - 76%, Urotrast - 76%). The solution is injected into the uterine cavity under aseptic conditions using a special guide with a tip, after which an x-ray is taken.

Laparoscopy.

A technique that allows you to examine the pelvic and abdominal organs against the background of pneumoperitoneum. The optics of the laparoscope are inserted into the abdominal cavity through a small incision, which makes it possible to directly examine the pelvic organs or by connecting a video camera to transmit the image to the monitor. It is difficult to overestimate the diagnostic capabilities that practical gynecology has gained with the introduction of laparoscopy into everyday practice. The widespread introduction of operative laparoscopy has truly revolutionized gynecology, significantly expanding the possibilities of providing highly qualified care to all groups of gynecological patients. Thanks to laparoscopy, small forms of external endometriosis were identified for the first time, and it became possible to find out the causes of chronic pelvic pain. Using this technique, you can differentiate inflammatory processes in the appendages, appendix, in a matter of minutes make a diagnosis of ectopic pregnancy, etc. The method is indispensable in the diagnosis and treatment of various forms of infertility, ovarian tumors, malformations of the internal genital organs, etc.

Computed tomography (CT).

The essence of the method is as follows. A thin beam of X-ray radiation falls on the area of the body under study from various directions, and the emitter moves around the object under study. When passing through tissues of different densities, the beam intensity is weakened, which is recorded by highly sensitive detectors in each direction. The information obtained in this way is entered into a computer, which makes it possible to determine the value of local absorption at each point of the layer under study. Since different human organs and tissues have different values of absorption coefficient, the presence of a pathological process can be judged from the ratio of these coefficients for normal and pathological tissues. Using CT, you can obtain longitudinal images of the area under study, reconstruct sections and ultimately obtain a section in the sagittal, frontal or any given plane, which gives a complete picture of the organ under study and the nature of the pathological process.

Magnetic resonance imaging (MRI).

The method is based on the phenomenon of magnetic resonance, which occurs when exposed to constant magnetic fields and electromagnetic pulses in the radio frequency range. To obtain an image, MRI uses the effect of absorption of electromagnetic field energy by hydrogen atoms of the human body placed in a strong magnetic field. Next, the received signals are processed, which makes it possible to obtain an image of the object under study in different planes.

The method is harmless, since magnetic resonance signals do not damage cellular structures and do not stimulate pathological processes at the molecular level.

Gynecology includes a set of tests and diagnostic methods that every woman will have to undergo more than once. An examination by a gynecologist is especially important for that category of women who suspect they have a gynecological disease, are planning motherhood, or are preparing to become a mother. Let's look at exactly what mandatory tests and studies are included in an examination by a gynecologist, how they are carried out and what they can show.

THE COST OF AN APPOINTMENT WITH A GYNECOLOGIST IN OUR CLINIC IS 1000 rubles.

External gynecological examination

External examination is a simple but very important gynecological examination, which is carried out both as a preventative measure and for direct diagnosis of pathology (in the presence of characteristic complaints or symptoms). During this examination, the doctor pays special attention to all organs located in the anogenital area - the pubis, external and internal labia, anus. After this, the internal condition of the vagina is assessed (examination of the cervix).

During a superficial examination of the genital organs, the doctor, first of all, focuses on such points as:

skin condition (dry, oily, greasy, etc.);
the nature of the hairline (sparse or thick hair, condition of the hair roots, presence of power lines, etc.);
the presence of bulges or any tumors on the surface of the genital organs;
redness, swelling of areas of the skin or the entire organ.

During a more detailed examination, the doctor spreads the external labia and conducts a visual analysis of the state of the genital anatomical structures, assessing:

clitoris;
inner labia;
opening of the urinary canal;
vagina (outside);
hymen (in teenagers).

During such an examination, the doctor may notice pathological discharge, which will indicate some kind of disorder in the woman’s body. In such a situation, an additional bacterial culture test or smear microscopy is required. This will allow you to accurately determine the presence of the disease and find out its causative agent.

Gynecological examinations for women and girls are different!

Gynecological examination with colposcopy

During this procedure, a gynecologist examines the woman's internal organs - the cervix, vagina and vulva. The examination is carried out using a special device - a colposcope. A gynecological examination with a colposcope is an accessible and informative procedure. The process is absolutely painless.

When colposcopy is prescribed, contraindications

As a rule, examination with a colposcope is recommended every six months, but it is not mandatory for healthy women. Colposcopy is required if significant abnormalities are detected as a result of the analysis of the LBC smear or PAP test.

Colposcopy is also prescribed if:

warts in the genital area;
cervical erosion;
inflammation of the cervix at any stage;
suspicion of presence cancer in the vagina;
uterine cancer;
significant changes in the shape and size of the vulva;
cancerous tumor on the vulva;
precancer, vaginal cancer.

There are no contraindications for this study, but the doctor will not do the examination on critical days and during pregnancy unless there are serious indications for this.

The gynecologist will prescribe an examination with a colposcope during pregnancy if the procedure cannot be postponed until the baby is born, due to a serious threat to the health of the expectant mother. Naturally, the examination by a gynecologist will be carried out with special care so as not to provoke a miscarriage.

Preparation for colposcopic examination

Before performing a colposcopy, the gynecologist will give the following recommendations:

Abstinence from sexual activity, even with a regular partner, for at least three days before the study;
If there are any diseases or inflammatory processes on the genitals, the woman is strictly recommended to refrain from treating them with suppositories and other vaginal remedies. Treatment can be continued after a gynecological examination.
If you are hypersensitive to pain, you can take it before the examination. painkiller tablet. Your doctor will prescribe pain medication.

As for the date of appointment for colposcopy, it is determined solely by the gynecologist.

How is a gynecologist examined with a colposcope?

Colposcopy is a routine gynecological examination with enhanced imaging. It is carried out in a completely non-contact way, using a modern device with a built-in microscope and static lighting, with lenses. An examination by a gynecologist in a modern clinic using a colposcope is the norm in Europe!

The device is installed on a special tripod in front of the woman’s vaginal opening. Next, the gynecologist, using a built-in microscope, examines the vaginal tissues under very high magnification, which makes it possible to note even the smallest changes in them. Lighting also helps the gynecologist. The gynecologist, by changing the angle of the light source, can examine scars or folds on the vaginal lining from all angles.

Typically, colcoscopy is performed with a detailed examination of the cervix and vulva. To better examine the surfaces, the gynecologist first removes the discharge using a tampon. Then, to prevent subsequent discharge, the surface of the cervix is lubricated with a 3% solution of acetic acid. If such preparation is not carried out, then, unfortunately, it will not be possible to obtain accurate results. There is no need to be afraid of this moment - the most a woman feels during a gynecological examination is a slight burning sensation in the vagina.

What will an examination with a gynecologist with a colposcope show?

As mentioned earlier, a colposcope allows the doctor to examine even the smallest changes in the structure and color of the epithelial cells of the vagina, which means it is able to detect any ailments at an early stage of development.

One of the most common diseases detected by a gynecologist with a colposcope is cervical erosion. Characteristic symptoms of erosion are uneven coloring, disruption of the epithelial layer, bleeding, etc.
Another disease that can be detected with a colposcope is ectopia. With ectopia, the doctor observes significant changes in the shape and color of the epithelium. This is a precancerous condition.
A pathology that is easily detected during examination with a colposcope is polyps. These are outgrowths of different sizes and shapes. Polyps are dangerous and can quickly increase in size, so they are removed.
No less dangerous are papillomas that populate the walls of the vagina. These formations can develop into cancer. Papillomas easily reveal themselves when a 3% acetic acid solution is applied to them - they turn pale.
During colposcopy, the doctor may see thickening of the inner lining of the vagina, which indicates the presence of leukoplakia. If treatment for this pathology is not started in time, tumors may form on the cervix.

The most dangerous disease detected by colposcopic examination during examination by a gynecologist is cervical cancer. If this disease is detected, a biopsy is performed immediately without fail.

Complications, consequences after a gynecological examination with colposcopy

Colposcopy usually does not cause any complications. The normal condition of a woman after a colposcopy procedure is light bleeding.

In rare cases, one of the bleeding options may occur. In this case, you need to urgently contact a gynecologist. Another unpleasant symptom of incipient inflammation is severe cutting pain in the lower abdomen.

Examination by a gynecologist with biopsy

The most important test prescribed for girls and women in gynecology is a biopsy. A biopsy is not considered a mandatory test during a gynecological examination, and is carried out on an individual doctor’s prescription. Its task is to confirm or refute the diagnosis of cancer. If the gynecologist recommends a biopsy, there is no need to panic - often the examination shows that the tumor is associated with inflammation or other processes.

Preparing and performing a biopsy

Diagnostics does not require additional preparation and involves taking biomaterials from the woman’s internal genital organs. A gynecological examination with biopsy is painless and lasts no more than 20 minutes. The tissues are examined under a microscope in the laboratory. The gynecologist will be able to announce the results of the study only after 2 weeks.

In total, there are about 13 different types of biopsies, only 4 of them are used in gynecology. These techniques are the most effective and informative when examining the female reproductive system:

Incision type - made by scalpel incision of internal tissues;
Targeted type - carried out by colposcopy or hysteroscopy;
Aspiration type - extraction of the material necessary for research by aspiration - vacuum suction;
Laparoscopic type - taking material for research using special equipment. This analysis is taken from the ovaries.

Before the biopsy, you will need to donate blood and urine to exclude complications after the procedure.

Contraindications and complications after a gynecological examination with biopsy

A biopsy performed by a good gynecologist under sterile conditions is safe. But it also has contraindications. A biopsy cannot be done if it is diagnosed:

blood clotting disorder;
internal bleeding;
allergies to the drugs used - anesthesia, aseptic treatment, etc.

After a biopsy, a woman may feel tolerable pain in the vaginal area or lower abdomen. However, the nature of the pain should be strictly pulling. In case of cutting pain, usually accompanied by bleeding, the patient should immediately contact a gynecologist for a re-examination.

You will need to refrain from strenuous physical activity and intimate contact for several days. If no abnormalities are observed in a woman’s body after this procedure, this does not mean that you can violate the gynecologist’s instructions and not come for a re-examination by the gynecologist.

As you can see, an examination by a gynecologist, even in its minimal form, provides extensive information about women’s health!

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