Gynecological examination mainly includes systemic examination, abdominal examination and pelvic examination. Check the condition of the vulva, vagina, cervix and uterus, fallopian tubes, ovaries and parametrial tissues and pelvic lining. Its main function is to provide early diagnosis, prevention and early treatment of some gynecological diseases. Gynecological examination is different from other departments, and pelvic examination is a unique examination of gynecological examination. After women discover that they are infected with gynecological diseases, they must go to a regular hospital to receive professional examinations, and annual physical examinations are also very important.

1. Full body examination

Including measuring body temperature, pulse, respiration, blood pressure, and height and weight if necessary. Other examinations are the same as other internal medical examinations.

2. Abdominal examination

is an important part. Looking, touching, percussing, and listening should be carried out systematically before the pelvic examination. Observe the shape of the abdomen, whether there is a dragon riding or a frog belly shape, whether there are scars, varicose veins, etc. on the abdominal wall. In the clinic, the abdominal wall is soft and tense, whether there is tenderness, rebound tenderness or muscle tension, and whether the mass can be palpated. Touch the liver, spleen, and kidneys for enlargement and tenderness. Pay attention to the presence of shifting dullness during percussion.

3. Pelvic examination

(1) Vulvar examination to observe the development of the vulva, the amount and distribution of pubic hair. In a normal vulva, the pubic hair is pointed downward and distributed in a triangle. There are no ulcers, dermatitis, vegetations or hypopigmentation in the perineum. The mucosa around the urethral opening is light pink and there are no vegetations. Married women have old cracks in their hymen, and pregnant women have old cracks in their hymen and perineum, or there may be incision scars on the perineum. When necessary, doctors sometimes instruct patients to hold their breath downward to observe whether there is bulging of the front and rear vaginal walls, uterine prolapse, or urinary incontinence. Any abnormalities will be recorded in detail.

(2) Use a speculum for vaginal examination: use gentle movements to avoid bleeding caused by friction. The normal vaginal wall mucosa is light pink in color, with wrinkles, and no congenital malformations such as ulcers, vegetations, cysts, vaginal septum, and double vagina. Normal vaginal secretions are egg white or white paste, have no fishy smell, and are small in amount, but increase during ovulation and pregnancy. If there is any abnormality, the patient may experience local itching, burning sensation, etc. If there is abnormal leucorrhea, you can remove the secretions at this time and conduct a smear to look for trichomonas, candida, gonococci and clue cells, etc., and perform bacterial culture if necessary. Leucorrhea is a mixture of vaginal mucosal exudates, cervical canal and endometrial gland secretions, and its formation is related to the action of estrogen.

General leucorrhea cleanliness can be divided into 4 levels:

Grade I: A large number of vaginal epithelial cells and a large number of vaginal bacilli are seen under the microscope.

II degree: Under the microscope, vaginal epithelial cells, a small number of white blood cells, some vaginal bacilli, and a few miscellaneous bacteria or pus cells can be seen.

Grade III: A small amount of vaginal bacilli, a large number of pus cells and miscellaneous bacteria are seen under the microscope.

Grade IV: No vaginal bacilli are seen under the microscope, except for a small amount of epithelial cells, mainly pus cells and miscellaneous bacteria.

Note: Degrees Ⅰ to Ⅱ are normal, and grades Ⅲ to Ⅳ are abnormal leucorrhea, indicating vaginal inflammation.

(3) Cervical examination shows a normal bulge around the cervix with a hole in the middle. The ones in nulliparous women are round, while those in postpartum women are in the shape of a "-". They are tough, red in color, and have a smooth surface. If the examination is normal, it means light, medium quality, no itching or pain, etc. If abnormalities are found, the degree of erosion (mild, moderate, severe), the degree of cervical hypertrophy, and the size and location of the vegetation will be described in detail. At this time, cervical cancer prevention scraping exfoliated cytology examination is feasible. This is the main method of cancer prevention census and is of great value in diagnosing cervical precancerous lesions and early cervical cancer.

(4) For uterine and appendage examination, the examiner wears gloves, applies lubricant to the index finger and middle finger, then gently passes two or one fingers through the vaginal opening along the back wall into the vagina, and uses the other hand on the abdomen to cooperate with the inspection. , called bimanual diagnosis. Bimanual examination is the most important item in the pelvic examination. The purpose is to detect abnormalities in the vagina, cervix, uterus, adnexa, uterine ligaments and parametrial connective tissue, as well as other organs and tissues in the pelvic cavity. A normal uterus is inverted pear-shaped, 7 to 8 cm long, 4 to 5 cm wide, and 2 to 3 cm thick. It has a medium-hard texture and good mobility. The ovaries and fallopian tubes are collectively called "accessories" and feel slightly sore and swollen when touched. Normal fallopian tubes cannot be palpated. If the patient feels pain when the cervix is ??pushed upward or to both sides, it is called cervical tenderness, which is a symptom of disease in the pelvic organs. If included, attention should be paid to the location, size, shape, mobility, relationship with the uterus, and the presence or absence of tenderness.

(5) Trimanual diagnosis is a joint examination of the abdomen, vagina, and rectum, which is a supplementary examination to bimanual diagnosis. It can be used to understand the size of the retroflexed uterus; whether there are lesions on the posterior wall of the uterus, the uterine rectal pit or the uterosacral ligament, especially the infiltration range of cancer and whether there are lesions in the vaginal rectal septum, the front of the sacrum or the rectum.

Rectal-abdominal diagnosis: suitable for patients with no sexual history, vaginal atresia or other reasons who are not suitable for bimanual diagnosis.

(6) Recording of pelvic examination results. Through pelvic examination, record the examination results in the order of the following anatomical parts. ① Vulva: development status, marriage and birth pattern, any abnormalities should be described in detail. ② Vagina: whether it is smooth, the condition of the vaginal mucosa, the amount, color, and character of the secretions, and whether there is any odor. ③Cervix: size, hardness, presence of epithelial ectopia, tears, polyps, glandular cysts, contact bleeding and pain during lifting. ④ Uterine body: location, size, hardness, mobility, and whether there is tenderness, etc.

⑤ Fallopian tubes and ovaries: whether there are masses, thickening or tenderness. If a lump is palpable, record its location, size, hardness, smooth surface, mobility, tenderness, and relationship with the uterus and pelvic wall. The left and right conditions need to be recorded separately.

(7) Basic requirements for pelvic examination ① Move gently; ② Instruct the patient to empty the bladder before the examination. If the stool is full, the examination should be done after defecation; ③ Generally, pelvic examination should be avoided during menstruation, and patients with abnormal bleeding should be avoided except. Disinfect the vulva before examination and use sterile gloves and instruments to prevent infection; ④ Hip pads should be replaced for each person examined to prevent cross-infection; ⑤ In the bladder lithotomy position, the examiner faces the patient and stands between the patient's legs. Critically ill patients who are not suitable for moving can be examined on the hospital bed; ⑥ For unmarried patients who deny sexual life, bimanual examination and vaginal speculum examination are prohibited, and anal and abdominal examination should be performed. If necessary, with the consent of the patient and his or her family members, the patient can enter slowly using an index finger or conduct the examination under anesthesia. ⑦The temperature of the gynecological examination room should be moderate, and attention should be paid to keeping warm when it is cold; the environment should be as quiet as possible to make patients feel comfortable and reassured. ⑧Avoid pelvic examination during menstrual period. If abnormal vaginal bleeding requires a gynecological examination, the vulva should be disinfected first and sterile instruments and gloves should be used for examination. ⑨When male doctors examine unmarried patients, other women must be present to reduce the patient's nervousness and avoid unnecessary misunderstandings. ⑩ For patients with abdominal wall hypertrophy or high tension who are suspected of having uterine or appendage lesions, if the pelvic examination cannot clearly understand the condition of the uterus and appendages, a B-mode ultrasound examination should be performed. If necessary, a gynecological examination can be performed under anesthesia.

4. Other examinations

(1) Pelvic and vaginal B-ultrasound can detect uterine fibroids, ovarian cysts and other lesions early.

(2) Colposcopy Colposcopy cannot directly diagnose whether you have cancer, but it can assist in the biopsy of cervical cancer. According to statistics, with the help of colposcopy, the diagnosis rate of early cervical cancer is as high as 98%.

(3) Hysteroscopy can simultaneously understand the endometrium and fallopian tube patency.

(4) Laparoscopy This examination is expensive, but it is highly accurate. When the first visit is not suitable, but the cause cannot be found after repeated examinations, laparoscopy can be used to understand the situation of pelvic adhesions, and a fallopian tube patency test can be performed at the same time, but it requires anesthesia and hospitalization.

(5) Check the fallopian tubes. If the previous gynecological examinations are normal, you need to do a fallopian tube fluid test 3 to 5 days after menstruation. This is the simplest method. If the fallopian tubes are blocked, treatment is needed to unblock them.

(6) Check the levels of reproductive hormones including estrogen, progesterone, androgen, follicle-stimulating hormone, luteinizing hormone, prolactin, testosterone, human chorionic gonadotropin, etc. Blood tests need to be done within the 2nd to 5th day of menstruation.