Author: Tan Xianjie (Peking Union Medical College Hospital)
Routine gynecological examination is one of the most common examination methods in gynecology, and obstetricians and gynecologists mainly use visual and palpation to understand the health status of female reproductive organs.
Through gynecological examination, many gynecological benign and malignant diseases can be diagnosed and treated early. Almost every woman undergoes a gynecological examination in her lifetime.
Are gynecological examinations scary? It's not scary to know!
1. What do you want to do for gynecological examination?
First of all, you need to take off your pants, the general requirement is to take off two shoes and one trouser leg, not to take off your shirt, and then sit on the bed of the disposable mat or disinfectant mat that has been laid in advance and lie on your back.
After that, the doctor will ask you to take the special position required for the gynecological examination - the bladder amputation position.
The "bladder amputation" is when you lie down on your back, place your legs apart on the leg frames on either side of the examination bed, and move your hips to the edge of the bed to maximize the exposure of the perineum.
Finally, the doctor will use a vaginal speculum to perform a gynecological examination of you.
Image source: Stand Cool Helo
Second, what can the doctor observe with his eyes?
First of all, the doctor sees whether there is tumor, inflammation, genital warts, etc. in the vulva. For patients with genital tract abnormalities and menstrual abnormalities, doctors need to check whether the hymen has atresia, whether the vagina is unobstructed, and whether there are abnormalities in vulvar development.
For women who have sex, a vaginal speculum is used for gynecological examination. The role of the vaginal speculum is to open the vulva and vagina, exposing the vaginal wall and cervix.
The shape of the speculum is like a duck's mouth, the model is divided into sizes, according to the width and narrowness of the vagina, and the elderly women generally use a small size.
In order to reduce the discomfort during the examination, the doctor will generally avoid the sensitive perurethral area and the anterior vaginal wall when placing the speculum, slowly insert it along the posterior vaginal wall in an oblique row, and turn the two lobes of the speculum and gradually open it as you push forward, exposing the cervix, vaginal wall and dome, and then rotate the speculum to fully expose the vaginal walls.
Before removing the speculum, close the anterior and posterior lobes and slowly remove them along the posterior vaginal wall.
The doctor will observe the color of the mucous membrane of the vaginal wall, how many folds, whether there are deformities such as vaginal septum or double vagina, whether there are ulcers, vegetations or cysts, etc., and will also pay attention to the amount, nature, color, and odor of vaginal endocrine.
If vaginal discharge is abnormal, tests such as trichomoniasis, mold (Candida), Neisseria gonorrhoeae, and cue cells are required.
After the cervix is exposed to the cervix, doctors look for the size, color, shape of the external mouth, bleeding, hypertrophy, erosion-like changes, tears, valgus, cysts, vegetations, and the presence or absence of bleeding or discharge in the cervical canal.
More importantly, cervical exfoliated cells are taken for cytology (e.g., TCT) and human papillomavirus (HPV) testing.
3. What palpation tests the doctor will perform
Palpation is followed by palpation, usually with three tests: bijoby, triad, and rectal and abdominal examination.
In the case of a double consultation, the doctor inserts two or one finger of one hand into the vagina, and the other hand cooperates with the abdomen to check the vagina, cervix, uterine body, fallopian tubes, ovaries, and parauterine connective tissue for abnormalities.
Triad refers to a combination of rectal, vaginal, and abdominal examination. At the end of the double consultation, the doctor will put the index finger into the vagina, the middle finger will be inserted into the rectum through the anus, and the other hand will be examined in the abdomen, which is an important supplement to the insufficient double joint examination, especially in the examination of reproductive organ tumors, tuberculosis, endometriosis, and gynecological inflammation.
Rectal abdominal examination is one hand into the rectum, the other hand in the abdomen to cooperate with the examination, suitable for women with no sex, vaginal atresia or other reasons are not suitable for double consultation.
Other test steps are combined with the double.
Fourth, what are the gynecological examinations that need special attention
If you have two fingers in the vagina during the doctor's examination and you can't stand it, tell the doctor that the doctor can switch to one finger for the examination.
In order to relieve your nervousness and help your abs relax, the doctor will ask you a few questions about your medical history or chat about homework, and when you answer the question, you will open your mouth to breathe, and your abdomen will relax.
During a triptych and rectal abdominal examination, your doctor will hold your breath downwards as if you were defecating, so your sphincter relaxes and pain and discomfort are reduced.
If the gynecological examination is very painful for you, or if you are not satisfied with the examination, you can switch to an ultrasound or other imaging test.
Doctors can also perform pelvic examination after anesthesia for women who suspect malignant lesions in the pelvic abdominal cavity, but have a thick abdominal wall and are highly nervous and difficult to cooperate.
Fifth, female friends themselves need to pay attention to the following problems
1. Those who have no history of sex life should inform the doctor
For those with no history of asexual life, that is, virgins, it is forbidden to do vaginal speculum examination and double and triple examination, and remember to prompt the doctor before examination.
2. Empty the bladder before examination
Except for women who present for urinary incontinence, the bladder should be emptied before the gynecological examination so as not to affect the accuracy of the examination.
If there is stool, it is best to empty, and patients with constipation can use medication to help.
3. Avoid menstruation
In general, pelvic examination should be avoided during menstruation, unless abnormal vaginal bleeding requires clarification of the cause of the bleeding.
Gynaecological examinations may have some discomfort, but generally do not pose a danger, and you do not have to be nervous. It is recommended that female friends undergo a gynecological examination once a year, so that many gynecological diseases can be detected in time.
*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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