"Lie down, take your pants off, and open your legs."
This is the most commonly heard phrase when going to the gynecological department for internal examinations.
It was embarrassing not only to swing the intimate parts in a large font, but also to be explored back and forth by two fingers of others into the vagina, and if it happened to meet a male doctor again, it was a large social death scene.
So such an embarrassing inspection, what is it looking for? Is there really no substitute for it?
What we call internal examination is actually palpation, which is part of the pelvic examination.
It also includes examination of the vulva, vagina, cervix, uterine body, and bilateral appendages, which are divided into internal and external examinations. This process is not only to be seen with the eyes, but also with the fingers.
Image source: Stand Cool Helo
(Tools required for internal examinations)
Looking is visually examining whether there are abnormalities in the visual range; touching is to check the organs inside the pelvic cavity from the touch, as well as whether the peripheral organs are abnormal.
Doctors will make more accurate judgments about the disease based on the patient's clinical presentation and in conjunction with other gynecological tests. If necessary, further vaginal discharge tests, cervical exfoliation cell tests, and HPV tests are done.
1. Vulvar examination
Use your eyes first.
The examination is from the outside in, and the first thing that catches the eye is the vulva. First of all, look at the vulva, labia majora; open the labia minora, the urethral opening and vaginal opening will be exposed; you can check the hymen, and whether these sights are different from ordinary people, such as developmental deformities, color changes, vegetations, etc. are the focus of the vulva examination.
2. Vaginal speculum examination
The need for tools is also the most feared step for many girls.
Because a duck-billed speculum is placed in the vagina to prop it open, this can completely expose the vaginal wall and cervix, which is convenient for observing the color of the vaginal wall, wrinkles, deformities, vegetations, cysts, vaginal secretions, etc., and do routine vaginal examination.
Cervical size, color, shape, bleeding, hypertrophy, polyps, secretions, etc. can also be observed, and exfoliation cytology and HPV detection can be done at the same time [1].
3. Double and triple consultation
Finally by hand.
This is the most common form of examination in internal examination. Doctors need to put one or two fingers of one hand into the vagina, and the other hand in the abdomen to cooperate with the examination, which is also the most embarrassing time, the double joint examination can check the vagina, cervix, uterine body, adnexities, parauterine connective tissue and the inner wall of the pelvic cavity for abnormalities.
Unlike double conjunction, triple consultation involves inserting one finger into the rectum, and the examination method is the same as that of double combination.
Triads provide a clearer understanding of the relationship between masses located in the posterior pelvic and rectal hysteresis and the uterus or rectum, and can also assist in identifying lesions in the extremely flexed uterus, vaginal rectal septum, paracervix, and uterosacral ligaments. It is particularly important for the diagnosis of genital tumors, tuberculosis, and endometriosis [2].
However, internal examination is only suitable for women with a history of sexual life, and if the patient has no history of sexual life, rectal-abdominal examination is more appropriate.
Is it really necessary for the doctor to let me go to bed at every turn?
For asymptomatic, non-pregnant adult women, internal examination is not mandatory [3]. However, as long as clinical symptoms appear, an internal examination must be done. As [2]:
1. Abnormal vaginal discharge, may be due to vaginal discharge and other inflammatory diseases such as vaginitis and pelvic inflammatory diseases;
2. Various irregular vaginal bleeding, which may therefore detect the presence of malignant tumors;
3. Infertility, which may therefore find abnormal genital structures or endometriosis;
4. Pelvic organ prolapse or urinary incontinence in order to assess the degree of prolapse;
5. Pelvic pain and difficulty in sexual intercourse can further identify the cause.
To put it simply, internal examination is an indispensable part of gynecological examination, which can help doctors judge diseases more accurately, so it is still necessary to do it when it is time to do it!
Of course not!
First of all, from an economic point of view, internal diagnosis is more cost-effective, basically an additional attribute of registered medical treatment, and the cost will not increase under the premise of not sending vaginal and cervical samples.
Secondly, from the diagnosis of the disease, internal diagnosis can improve the efficiency of examination, because most diseases will not have only one cause, some examinations need to be directly observed under the speculum or taken under the specular lens, can not be found through imaging examination, if only with machine inspection, it can only be widely cast a net of exclusion, too time-consuming and laborious.
Therefore, the doctor will have a general assessment of the disease according to the patient's clinical manifestations and the results of the internal examination, and then choose a targeted examination, which not only reduces the examination procedure, but also can find many hidden diseases that are not easy to be directly discovered by the machine in advance, so as to diagnose and treat early.
In addition, many women lack medical knowledge, do not take many symptoms seriously, or do not find the existence of these abnormal symptoms at all. Through pelvic examination, while bringing the doctor and patient closer to communication, you can also detect the presence of the disease in advance.
Internal consultation is a doctor's helper to help women diagnose and treat diseases, and you must not delay your illness because of your shyness. Adjusting the mentality and facing it correctly can establish a good doctor-patient communication.
Review expert: Liu Haiphong | Deputy Chief Physician of the Department of Obstetrics and Gynecology, Huashan Hospital, Fudan University
bibliography
Xie Xing, Kong Beihua, Duan Tao. Obstetrics and Gynecology (9th Edition)[M]. People's Medical Publishing House: Beijing, 2018.
Zhang Shiqian. Basics-based, basic skills: Clinical recommendations for pelvic examination[J].Chinese Journal of Practical Gynecology and Obstetrics,2020,36(12):1132-1136.
[3] Luo Manling, Hu Haiyan, Zhong Mei.2017 USPSTF Recommendation Statement: Guidelines for Obstetric and Gynecological Disease Screening by Pelvic Examination[J].Obstetrics and Gynecology and Genetics (Electronic Edition), 2017,7(03):7-8.
[4] Xu Jiaojiao,Wei Shiyuan,Ouyang Zhenbo,Gao Tianyang. Interpretation of the effectiveness of routine pelvic examination and indications statement of ACOG[J].Advances in Modern Obstetrics and Gynecology,2019,28(08):621-623.
*The content of this article is a popularization of health knowledge and cannot be used as a specific diagnosis and treatment recommendation, nor is it a substitute for face-to-face consultation by a practicing physician, for reference only.
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