Pelvic exam

Gynecological examination consists of a survey (clarifying the complaints, anamnesis) and objective examination of women. There is some connection between gynecological diseases and age women: in the period of puberty are identified menstrual irregularities, underdevelopment of the genitals, sometimes reveals tumors of the ovaries; in adulthood are more common inflammatory diseases of the uterine appendages, pathology of pregnancy (starting miscarriage, placental polyp, ectopic pregnancy), neoplasms; menopause - functional uterine bleeding tumors of the uterus (fibroids ); menopause possible ovarian cancer of the uterus, omission.
Gynecological examination it is necessary to clarify the nature of menstrual cycles (the duration of their monthly mobility) former pregnant - period last pregnancy and its course (childbirth, abortion). If the last pregnancy was over three years ago (in spite of regular sexual life without the use of contraceptives), we can assume a possibility of chronic adnexitis (see), leading to secondary infertility.
To find out when was and how was the last menstruation.
On the basis of the survey and the data of the anamnesis it is possible to make an assumption about the possibility of a disease. The final diagnosis of the disease can be delivered only after thorough physical examination.
Before gynecological examination, the woman should empty your bladder to empty the bowel. Gynecological examination begins with a General survey. Pale skin can be observed for bleeding (for example, due to fibroids). We must remember that in malignant tumors cachexia (see) develops late; in the early stages of the General condition of the patients often remains satisfactory.
Palpation of the abdomen (Fig. 1) is particularly important in the presence or suspected tumors of the ovary, acute inflammation of the appendages, pelvioperitonit; in these cases, palpation is more convenient to start on the couch. To relax the muscles of the abdomen patient should slightly bend your knees. In the presence of the tumor determine its value, consistency, removability. Suspected malignant tumor need to try to establish whether any of ascites. In acute inflammation of the appendages and pelvioperitonit first of all it is necessary to establish whether the abdominal wall in the act of respiration; then, producing carefully palpation, find out the most painful abdomen.
Inspection of vulvar and vaginal examination produce horizontal women (on the back), with a slightly higher pelvis, with widely divorced thigh and bent at the knee and hip joints of the lower limbs. Examination easier to produce on the gynecological chair. Must be procured oilcloth, which put each woman in the chair, used to be dumped into the pelvis for disinfection. Before exploring the wash hands with brushes, then in a basin with a solution of bleach or the sublimate. If bleeding (incomplete abortion) wash hands more carefully, his fingers before introduction into the vagina lubricates alcoholic iodine solution. Vaginal speculum and bimanual (handed) research is better to make in rubber gloves. Last after each gynecological reception boil and pour talc.
For inspection of the external genitalia left hand is widely bred labia (the presence of a discharge their character); examine the external opening of the urethra, the state of the hymen. The woman offered to potorytsia to install the possible omission of the walls of the vagina or cervix.
Vaginal examination easier to produce two fingers of the right hand. Widely spreading the left hand labia minora, enter the middle finger of the right hand, then, slightly pressing on the perineum, and the index finger. Thumb when it is put on the side, not on the scope of the clitoris (so as not to cause irritation). In antenatal women in the study can be conducted by one (index) finger.
Put your fingers examined the shape of the vagina, vaginal depth codes (when they infiltrate can be flattened; in these cases is palpated the lower pole of infiltration). Find the vaginal portion of the cervix, define outer uterine cervix. If it is impossible to touch the body of the uterus and appendages (peritonitis) need to try to shift the cervix; if such a shift does not cause any pain, we can assume that peritoneal phenomena are not associated with sexual apparatus. When a large tumor in the abdominal cavity (pregnancy?) you should pay attention to the consistency of the cervix (softness, her swelling during pregnancy!).
The main objective examination of the female genital organs - bimanual examination (two-handed). The fingers of the right hand remain introduced into the vagina, the left hand is placed on the abdominal wall (Fig. 2) on the middle line above the pubic area and gently make a deep palpation (find the uterus). The fingers of the right hand are located in the front arch. When thin abdominal wall of the uterus easily palpated; define her mobility and value.
In some cases (infiltration in the back parametrium, swelling of the ovaries), you can use premonicion-vaginal study: middle finger enter in a direct gut, and indicator in the vagina (on hand to put on a rubber glove). To premonicion-brunetoochka research resort at survey of women who have not lived sex life, and when Kintrishi.
Great value gynecological examination is an examination of the vagina and cervix vaginal mirrors. It is better to use spoonlike mirror Sims and a lift. Spreading the labia lips, gently edge impose lower mirror and only then, putting his pen down, put pressure on the perineum. Lift enter the edge to the side, and then the handle to lock up. Carefully guiding it into the vagina mirrors, able to see the cervix. Inspection mirrors especially important for mass prophylactic examinations, as it allows to identify women with the erosion of the cervix. Folding mirrors (Cusco) is easier to use for small procedures (vaginal baths and others). The midwife and nurse produce vaginal examination on the site and for detecting deviations from the norm send women to the gynecologist.
During mass prophylactic examinations every woman examine individual prosterilizovat mirrors. A pelvic examination, in some cases, must be supplemented by special methods of examination. So, all women with inflammatory diseases of the cervical erosion, complaints Beli should be made direct microscopic examination of smears taken from the cervix and urethra, in gonorrhea (see), trichomoniasis (see).


Gynaecological examination in girls. A necessary condition of gynaecological examination is the emptying of the bladder and the rectum (cleansing enema). A pelvic examination is done in the normal position on the table with diluted and given to the stomach legs, in good light the vulva; legs supports sister or a nurse.
The inspection. Big and index fingers of both hands with pieces of cotton wool capture large pussy lips and pulled them forward and down. Become a well available to the inspection of the labia minora, Maidenhead, outer hole in the urethra, the clitoris. The survey allows to note deviations in anatomical structure and development of the external genital organs, the nature of vaginal discharge, painting mucosa. You should pay attention to the traces of scratches, changes in the area of the anus (thickening perianal folds indicates infection pinworms).
Two-handed brunetoochka-rectal examination (Fig. 3) allows you to determine the size and position of the internal genitals.
Due to anatomic and physiological features of young girls uterus and appendages are somewhat higher than for adult women. Vaginal smear girls are carried out rarely and only for special reasons (bleeding, suspected tumor, the presence of foreign bodies, clarifying the reasons for the emergence whiter). The study produces only the doctor.
Instrumental examination of the vagina and cervix (vaginoscope) is made by a doctor. For inspection apply sight urethroscopy Valentine. Vaginoscope in children requires experience and great care not to disturb the integrity of hymen.