Internal investigation

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The study, produced introduced into the vagina with your fingers, called an internal investigation. In gynecological practice internal investigation should be combined (handed): one or two fingers of one hand enter the vagina, and the other hand is fixed through the abdominal wall of the investigated organ (the uterus appendages) or try to determine by palpation status of a particular area of small pelvis. An internal analysis is usually performed by a right hand; however, some prefer to explore the left. Is the study of one index finger or two - index and middle. The study should be made cautiously, without causing pain.
Getting started study that explores is faced with the patient lying on his back with legs bent and divorced feet. Using the thumb and forefinger of the left hand labia index finger of the right hand enter the vagina, paying attention to the sensitivity, the width of the entrance to the vagina, the elasticity of the walls.
It is necessary to consider that the most sensitive areas are the clitoris and the front wall of the vagina in the field of the urethra; therefore, when the vagina is not necessary to pressure them exploring a finger. The fingers must slide along the posterior vaginal wall, not on the front. If the introduction of the fingers due to the narrowness of the vagina is difficult, when they need to be otdelyvat crotch down, and his fingers pre-lubricated with vaseline.
Spending fingers deeper into the vagina determine the state of the mucous membrane (the degree of humidity, presence of razreshenii, roughness, the degree of smaduamei or, on the contrary, nepodalyoku if scarring), the presence of tumors, partitions (when you double vagina). Through the front wall of the vagina may to a considerable extent to prosuvalisya urethra (if he infiltrated).
Then explores finger found the vaginal portion of the cervix, determine its form (conic, cylindrical), the size, shape outside the uterine pharynx (the antenatal - round, parous - in the form of transverse cracks; Fig. 18), the presence on the neck breaks and scars after childbirth, tumors, etc., When deep transverse rupture on the neck, she seems to be divided into two lips (front and back), and mucous membrane of the cervical canal in such cases seems to be turned into the lumen of the vagina (ectropion) (Fig. 19-27). If on the neck sore, while touching the surface it sometimes seems velvety; ovula Nabothi felt in the form of small tubercles. Physiologically outer cervix cervix is closed. On cervical position to judge the displacement of the uterus. In norm the cervix is strictly on the middle line, outer jaws (in a standing position women) is facing downwards and backwards.
During the examination of the vaults determine their depth, width, smexiest mucosa, are there any protrusion, tumors, infiltrates, the last link with neighbouring authorities; pain is defined in the study or the lack of it.

Then proceed to the study of the overlying bodies and departments of the small pelvis.