A gynecological examination is a special procedure that helps a woman maintain her intimate health and detect serious diseases in their early stages. Regular visits to the gynecologist allows a woman to feel normal.
Before the examination, a woman needs to prepare and take into account several points:
- It is necessary to take a shower before taking. It is advisable not to wash the genitals;
- Avoid tampons and hygienic creams;
- Refuse to have sexual contact with your partner 24 hours before the scheduled examination;
- Before taking it is necessary to empty the intestines and bladder to avoid bloating and discomfort;
- Measure your main parameters: height, weight, pressure;
- Prepare your medical history if this is your first visit to an appointment.
How does it go
A complete gynecological examination includes the following points:
The mirror helps to carefully examine all 4 walls of the vagina, as well as the cervix and identify such abnormalities as:
- Changes in the cervix (ectopia, leukoplakia, dysplasia, hypertrophy, etc.);
- Cysts, fibroids or polyps on the cervix;
- Pubescence of the cervix and body of the uterus;
- Prolapse of the walls of the vagina.
After examination in the mirrors, the doctor takes a smear for microflora and abnormal cells, which is carried out with special disposable sticks and does not bring discomfort. After smears are transferred to the laboratory to identify pathological processes, infectious agents. If necessary, an additional visual examination of the cervix of the uterus is carried out - colposcopy.
Inspection of girls
When examining a girl who is not sexually active, the doctor does not use mirrors or additional instruments to prevent damage to the hymen. The doctor inserts the index finger of the right into the anus of the patient, and the other is located on the surface of the skin of the lower abdomen, as in the usual two-handed gynecological examination. In this way, internal organs, the cervix, the walls of the vagina, and appendages are probed. With this study, the girl remains a virgin.
Examination during pregnancy
In fact, the usual gynecological examination does not differ, except that a two-handed examination of the cervix is \u200b\u200bpredominantly and material is taken for examination (infection). At the same time, the woman is located on the couch, and not on the gynecological chair, which becomes difficult to climb with an increase in the gestational age. The patient needs to do a number of the same procedures that are recommended before admission.
During the entire period of pregnancy, the examination is carried out several times. With a healthy pregnancy, going to the gynecologist is limited to three appointments. If an infection is detected in the patient at the first appointment, then an additional examination may be required.
During menstruation
A trip to the gynecologist during menstruation is possible, but not recommended, since during this period it is difficult to accurately assess the state of the vaginal microflora and it is impossible to take smears for analysis.
But it is not worth postponing the examination if you are concerned about acute pain, blood discharge and temperature that are not typical for menstruation.
These symptoms may indicate an inflammatory process that must be quickly eliminated. Prolonged menstruation is no less a good reason to go to the doctor.
Bleeding after examination
May occur for the following reasons:
- Use of a gynecological mirror. If the instrument is used incorrectly, slight damage to the vaginal mucosa is possible, which provokes light bleeding;
- Taking a smear. During this procedure, the cells of the vaginal mucosa are scraped off and, at the same time, it is damaged;
- Pathological changes in the cervix, characterized by contact bleeding (ectropion, hyperplasia).
Minor discharge of blood after a gynecological examination is normal. This should not cause a woman to worry if the discharge has stopped within a few days.
Video: a fragment of the TV show "Live healthy" about the passage of a preventive examination by a gynecologist:
There comes a time in every woman's life when it's time to go to see a gynecologist. For many of them, and not only those who are faced with the situation for the first time, going to this doctor causes fear, discomfort and stress.
Most diseases associated with gynecology have a slow or asymptomatic course. Given this fact, it is impermissible to neglect the appointed inspection. The proposed article will answer all questions related to behavior at a gynecologist's appointment and various situations that arise before and during the process.
The main nuances of the examination by a gynecologist
Often women experience embarrassment when they find out that the appointment is being conducted by a male doctor. This feeling is connected with the psychological perception of a man as a male.
The patient begins to invest intimate overtones in the examination, which can significantly worsen the quality of the process.
Indeed, in this case, the woman behaves constrainedly, cannot relax and is embarrassed to ask her questions.
Therefore, a clear understanding should be recreated: a gynecologist is a doctor, and gender does not matter.
It is necessary to make a comparison, for example, with an otolaryngologist. Surely the gender of this doctor does not matter. The same understanding should be developed in relation to the gynecologist.
Actual! What matters is not the gender of the gynecologist, but his professional qualities.
During the examination, the doctor may have questions related to past illnesses or the nuances of the patient's intimate life.
Such questions arise not out of idle curiosity, but for a more accurate representation of the problem and the selection of effective methods for its elimination. Therefore, the answers should be meaningful, without omitting one or another point.
How often do you need to visit a gynecologist?
The first visit to the doctor is expected immediately after the establishment of a young girl's menstrual cycle. This age varies due to individual physiological characteristics. Usually this period is from 12 to 15 years.
Often, the organization of visits to the gynecological office is carried out by educational institutions where adolescent girls study.
In other cases, it is best for parents (especially mothers) to take care of choosing a gynecologist and the date of the visit.
Many ladies are mistaken, believing that if there is no cause for concern, a medical examination is not needed.
Important! After entering into sexual activity, a visit to the doctor becomes mandatory every six months.
If symptoms of a gynecological nature occur, it is not necessary to wait for the expiration of 6 months. And you need to immediately make an appointment with a doctor - a gynecologist.
These symptoms may include:
- The appearance of various discharges from the vagina (white, yellowish, greenish, brown, purulent, with an unpleasant odor, with blood, mucus).
- Spasms and, especially of a prolonged nature.
- Pain during intercourse;
- Deterioration of well-being during pregnancy or rehabilitation after surgery (abortion, removal of a cyst or uterine fibroids, etc.);
- Sharp pains during menstruation.
It should be remembered! These are just the main examples of cases requiring immediate medical attention. They can be supplemented by other symptoms, manifest with varying degrees of activity. It is possible that several problems are present at the same time.
For women in menopause, visits to the gynecologist are recommended to increase. This is due to the increased risk of oncological diseases in this period.
How to prepare for a gynecological appointment?
You should prepare in advance for the examination by a gynecologist (the only exception is emergency emergency treatment).
There are a number of points to pay attention to:
How is a gynecological examination carried out?
When visiting a gynecologist for the first time or when visiting a new gynecologist, the appointment begins with the recording of individual data.
A dialogue is established between the doctor and the patient, during which:
- the nature of the menstrual cycle and sexual life is established;
- chronic or previously transferred diseases are detected;
- the problems and concerns of the subject are voiced.
It is important to provide comprehensive information so that the gynecologist has an overall picture of intimate health and its possible problems. After the conversation is over, the specialist will proceed to the examination, which can be divided into external and internal.
During an external examination, the gynecologist measures weight, height, determines the external condition of the skin and genital organs, and examines the mammary glands. Sometimes their examination is carried out at the final stage.
Gynecological internal examination is carried out on a chair and includes two stages - vaginal and two-handed.
vaginal examination
Vaginal examination:
Important! Vaginal examination does not apply to girls who have not had sexual intercourse, as it can lead to a rupture of the hymen.
Two-handed inspection
Vaginal two-handed examination:
- It's time for a vaginal two-handed examination. Its essence lies in the fact that the doctor examines the uterus and ovaries with his hands, determining their size, location, etc.
- Palpation may cause pain. Their character is evaluated by a gynecologist.
After completion of the examination, a medical card is filled out. With a preliminary conclusion, additional studies may be needed (testing, visiting other specialists). Only when all the necessary procedures are carried out by the doctor, a diagnosis is made and, if necessary, treatment is prescribed.
What does the gynecologist see during the examination?
It is not always necessary to wait for test results to determine the problem. The doctor can detect some diseases already at external gynecological examination.
These include:
There are times when even pregnancy are found only by visible signs of the genital organs.
At internal examination tumors are detected. Polyps are visible with the help of mirrors. And during a palpation examination, a specialist determines the condition of the uterus, deviations from the normal are revealed. Of great importance is the examination of the mammary glands. With their palpation, mastopathy and other cystic diseases are determined.
Gynecological examination of virgins
In the absence of sexual relations, the examination of a young woman is carried out only externally. The doctor examines the genitals, probes the chest to identify seals and takes a swab.
Inspection features
If the patient has complaints, then an internal examination is performed rectally.
The gynecologist lubricates the index finger with a special lubricant and slowly inserts it into the hindgut. With the other hand, he palpates the abdomen.
This method allows you to examine the uterus and ovaries in virgins.
It is imperative for girls to relax and try not to worry during the examination, so as not to cause painful and unpleasant sensations.
A swab from virgins is taken from the labia minora.
When an ultrasound is prescribed, it will be carried out:
- through the abdomen (with a full bladder);
- through the rectum (preferably preliminary enema).
On a note! Girls under 14 years of age are examined by a gynecologist only with the permission of their parents (guardians).
Examination by a pediatric gynecologist
Few people know that 25% of girls of preschool age are diagnosed with gynecological diseases. In view of this, for girls there are scheduled examinations by a pediatric gynecologist.
The first scheduled examination is carried out in the maternity hospital. During it, the sex is established and the genitals are evaluated. The second inspection - before sending the child to kindergarten and the third - during preparation for school. As a rule, they are presented by external studies.
There are times when a girl needs unscheduled inspection.
It is necessary to carry it out in such cases:
- Problems with urination (frequent, painful).
- Itching and burning in the perineum or genitals.
- Presence of vaginal discharge.
- Early puberty.
- Cramps in the lower abdomen.
Inspection features
This type of inspection is a very delicate process. It is carried out only in the presence of the mother or guardian.
First, the gynecologist asks questions about the presence of complaints in the baby, the presence of pain in the lower abdomen and genitals.
Questions can also be addressed to the mother. They relate to childbirth and postpartum development of the girl. Then the doctor asks the little patient to take off her clothes.
This is necessary to assess the functioning of the hormonal system of the child.
Important! Before the start of the examination, the pediatric gynecologist establishes psychological contact with the subject.
Inspection of the genital organs is carried out on the couch, lying on the back. A two-hand examination is performed through the rectum. The use of a gynecological mirror is strictly contraindicated. Smears are taken carefully, using very thin instruments.
Should know! An internal examination of young girls is carried out only in cases where there are grounds for this procedure.
What pathologies can be in little girls?
In girls, the following pathologies of the genital organs may occur:
All of the above pathologies are curable with timely access to a doctor.
On a note! The occurrence of a disease in the genitals of girls is often associated with a violation of their hygiene. The baby can bring the infection with her fingers. Parents should have a gentle conversation about not touching certain parts of the body with dirty hands.
Examination by a gynecologist during pregnancy
With the onset of a wonderful time in a woman's life, gynecological examinations become systematic. In the process of each of them, the necessary facts of the course of pregnancy are established, tests and examinations are prescribed.
Important! It is strictly forbidden to neglect visits to the doctor during this period.
First appointment early
At the first appointment during pregnancy, the gynecologist enters 2 cards for the patient:
- individual
- exchange
The first will be in the doctor's office, and the second - in the pregnant woman (with her she will go to the hospital). They will record data on the condition of the woman and the fetus.
Questioning a woman by a gynecologist
An obstetrician-gynecologist conducts a conversation before the examination in order to compile an extended anamnesis.
Questions will concern the health of not only the future mother, but also the future father, as well as their immediate family.
This information is necessary to prevent the risk of complications in the course of pregnancy.
At the first appointment, it is measured:
The next stage is the examination on the chair:
- First, an external examination of the genital organs is performed.
- Then, with the help of a speculum, the vagina and cervix are examined.
- Necessary swabs are taken.
- After that, the pregnant woman is waiting for a bimanual examination. The condition of the cervix is determined, the uterus is examined and.
Important! Such a full examination at the first appointment during pregnancy is necessary to identify possible pathologies in a pregnant woman.
The inspection has come to an end. The pregnant woman can relax, and the doctor can start calculating the gestational age and EDD (estimated date of birth).
The gestational age is calculated from the first day of the last menstrual period ( obstetric term). This is a standard method of calculation and often it does not coincide with the real term. More accurate is embryonic period, calculated from the date of conception (during the period of ovulation). But in medicine, the first method of calculation is preferable.
To calculate the PDR, the formula is used:
the first day of the last menstruation - 3 months + 7 days.
The date received is not the final verdict, but only an approximate number (± 10-14 days).
When all the calculations have been made, the gynecologist remains to write out directions to the expectant mother for testing and examination of other specialists.
Required tests:
- OAM(general urine analysis);
- UAC(general blood analysis);
- Determination of blood group and Rh factor;
- Analysis for TORC - infections;
- Blood test for hepatitis B, C, syphilis and HIV- infections.
As a rule, the last two analyzes are assigned to both parents.
Expert review:
- Endocrinologist;
- Optometrist;
- Dentist;
- Therapist.
If the pregnant woman has other chronic diseases, she is given a referral to a specialist in this field.
At the end of the appointment, the obstetrician-gynecologist gives a number of recommendations related to proper, balanced nutrition, daily routine and lifestyle in general. The information provided is especially important for women who have not given birth before.
Should know! The first appointment with a gynecologist in connection with pregnancy is the registration of a pregnant woman. You need to sign up for it no later than the 12th week of pregnancy.
Check-ups during pregnancy
Scheduled inspections are just as important as the first one. The next appointment for a pregnant woman is scheduled two weeks after registration. By this time, she passes all the prescribed tests and visits the recommended specialists.
For the second appointment the gynecologist must have all the data on the health of the pregnant woman for the current period. Between 11-13 weeks appointed first screening.
It is represented by an ultrasound scan and a blood test to determine and protein. A double test determines the risk of chromosomal abnormalities in the fetus (Down syndrome, Edwards syndrome). This concludes the visits to the gynecologist in the first trimester.
In the second trimester, visits to the gynecologist should be at intervals of 1 time in 2 to 3 weeks:
In the third trimester, examinations become more frequent: until the 36th week, two per month, after - every week.
Gynecological examinations after childbirth
Depending on how the birth went, whether they were natural or had to resort to a caesarean section, the date of the examination by the gynecologist is set.
If the birth took place naturally, then the reception should take place after the normalization of vaginal discharge. In the first week, the discharge is bloody, similar to menstruation, but more abundant.
Then, they turn brownish-yellow and gradually return to normal values within 6-8 weeks.
If the birth took place by surgery, then you should consult a doctor a few days after discharge from the maternity hospital.
At the postpartum appointment, the specialist will assess the condition of the genitals, examine the stitches (if any), ask a number of questions about the course of childbirth, and talk about proper care and hygiene. If complications arise, additional procedures and tests will be prescribed.
Cases of emergency contact with a gynecologist include:
- Changes in the quality of secretions (color, quantity, consistency);
- Pain in the lower abdomen or in the area of the seam from a caesarean section;
- , redness, inflammation of the postoperative suture;
- Increase in body temperature.
Detection of pathologies and the body's reaction to a medical examination
The nature of the appearance of gynecological diseases is very diverse. Most of them are diagnosed during a gynecological examination.
During the examination, the patient may experience abdominal pain. The likely reason for this is the presence of inflammation of the genital organs. The pain may be accompanied by bloody discharge from the vagina. Such inflammations are usually caused by sexual transmission of the infection.
If the patient has an ovarian cyst, then with a two-handed examination, pain occurs when the area where it is located is probed.
There are cases when, after taking a smear, a woman has a small amount of brownish discharge. This is due to minor damage to the vaginal wall during the sampling. But the bleeding that occurs after examination in pregnant women is a cause for concern. They can be a signal for a miscarriage and require urgent treatment to the hospital.
If a woman has no problems in the field of gynecology, then there should not be any negative reactions. In order to provide for discomfort, before the examination, the body should be prepared: relax, empty the intestines and bladder.
In custody
Gynecological inspection- a useful and inevitable procedure for any woman. It can be both planned and urgent.
To avoid force majeure, all ladies should take note of the following tips:
Most women are afraid of a female doctor, like fire. And there is nothing surprising in this, because almost every woman’s acquaintance with an obstetrician-gynecologist begins not just with a visit to the doctor’s office and a survey, but with a gynecological examination, or, as the people say, an examination on a “helicopter”.
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And it would seem that there is nothing wrong with such inspections, if it were not for ...
Preventive gynecological examinations of adolescent girls
Long before a gynecological examination, the formation of disgust, fear and shame to visit a gynecologist in adolescent girls begins, when total “preventive” examinations are carried out in educational institutions. Until now, these examinations in many schools are carried out without the consent of the students themselves and their parents. The fact that any examination without parental permission is prohibited and not performed in most countries of the world is one important fact. Second, teenagers have the right to refuse any examination, with or without the presence of their parents, except in very rare cases, but these cases do not include school examinations.
Dear parents, remember: there can be no examination of your child by coercion or someone else's desire and without your consent (written or oral).
Young interns are often sent to conduct “preventive” examinations, less often pensioners earn extra money. Several doctors (therapist, surgeon, ophthalmologist, gynecologist, etc.) "accept" everything in one room (class), right next to the teacher. The girls are lined up and one by one they go through the "examinations" by the doctors in the presence of everyone in the class. It is good if there are special screens that create a certain privacy. Less often, such examinations are carried out in separate rooms equipped with everything necessary - this is the best option.
The most unpleasant stage is the examination by a gynecologist, performed mainly by some young, "green" intern or male doctor (as evil). He asks to lift her skirt, lower her pantyhose and underwear, puts her hands in her groin and feels something there (looking for enlarged lymph nodes, because this is how syphilis and gonorrhea are allegedly diagnosed). Other girls are standing nearby, teachers are sitting. On the faces of doctors and teachers - an expression of discontent, indifference or disgust - everyone wants to quickly carry out this "obligation" and, having reported, go about their business.
This is a classic scenario of gynecological examinations, carried out in school institutions since Soviet times, and this is still how “preventive” examinations are carried out in many post-Soviet schools. But what can be discovered by such unprofessional inspections? Usually nothing! In most countries of the world, such examinations are not carried out.
Some may argue that such examinations are useful, because many parents do not have a medical education, and therefore are not able to monitor the health of their children. But the medical education of parents plays the last role. Kind, attentive, sympathetic parents who take care of children will detect any violations in the child's health in advance and take him to the doctor. And those who care least of all about their offspring (and, unfortunately, there are enough of them), will not pay attention not only to the warnings of teachers that some deviations were found in the child, but also to the pronounced signs of some kind of disease, if the child complain to them about it. Such examinations in no way prevent the occurrence of epidemics of various infections (scabies, chicken pox, influenza, and others), since no matter how often children are examined, outbreaks of infectious and other diseases occur in schools outside of any examinations.
It is with such an unpleasant “acquaintance” with an obstetrician-gynecologist that a long-term relationship begins between a woman and a doctor.
Important rules for women
Let's return to gynecological examinations in a medical institution. First of all, women (especially young ones) are often shocked by the inattention of doctors. The interview process is reduced to a minimum and many important questions are not asked by the doctor. For example, whether a woman is sexually active, planning a pregnancy, had or had unprotected intercourse with the onset of her menstrual cycle, etc. It is important to know all this, otherwise it turns out that they are trying to insert “mirrors” into the vagina for a virgin, a woman who may be pregnant because she did not use protection, is prescribed a long list of medications and aggressively treats what is so urgently needed and is not needed. And then more than one woman clutches her head in despair - she didn’t know that she was pregnant, but she took so many medications, and now the same doctors advise having an abortion when pregnancy is so desired ...
Thus, it is important for women to remember four important rules:
1. Tell your doctor that you are a virgin or not, that you are engaged in sexual activity, not necessarily traditional in the vagina, or not.
2. Tell your doctor that you are planning a pregnancy, so you are not using protection against pregnancy, or vice versa.
3. If you are not using protection but your period is days away, do not rush into any treatment unless your condition is an emergency. Wait for menses. If they are delayed, get a blood test for β-hCG. With negative results, treatment can be started, with positive results - only according to strict indications.
4. All planned (non-emergency) invasive examination methods (laparoscopy, hysteroscopy) and surgical methods of treatment (cauterization, laser therapy, freezing of the cervix, removal of cysts, etc.) on the reproductive organs should be carried out only in the first half of the cycle.
Compliance with these rules will help to avoid many mistakes, complications and unforeseen negative consequences.
Gynecological examination and doctor skills
Another disappointment is the inability of doctors to perform gynecological examinations, despite the fact that this is part of their professional training.
How do women usually characterize such examinations themselves? Cold wooden hands that dig into the stomach with such force that even climb the wall. What a relaxation! And after such examinations, when a woman is writhing in discomfort and pain, the traditional conclusion is about “heaviness in the appendages”, which means “severe inflammation of the ovaries, adhesive disease” and a few more fashionable diagnoses.
It turns out that many doctors do not have the slightest feeling in their hands, especially in their fingers. The pads on the inner surface of the fingers are an extremely sensitive area: they can “see” and not just feel. However, few doctors use their senses. And in medical institutes, no one, with the exception of some teachers, teaches to conduct a gynecological examination, what to look for and find “inside”, how to use the sensitivity of the fingers (it is necessary not to press on the stomach as much as to feel with fingers and hands), although theoretically this is well described in all textbooks.
There are a lot of exercises to develop the sensitivity of the fingertips and palms of the hands, but most often such information can be found not in medical textbooks, but in publications on healing, medicine and other alternative healing methods.
Goals of a gynecological examination
It is impossible to imagine gynecology without a gynecological examination. Or are we just used to the fact that such an inspection should be and cannot be done without it?
What are gynecological examinations for, what can they reveal and how often should they be done? What should a female doctor examine? Traditionally, according to the old school of obstetrician-gynecologists, the doctor (and family doctor too) should examine the woman's skin, examine the mammary glands, superficial groups of lymph nodes, conduct a gynecological examination (through the vagina) and / or rectal examination (through the rectum). But which of the doctors does just such an examination in modern conditions? Units. Most believe that neither the skin, nor the chest, and even more so the anus, is not a gynecological industry.
If examination of the skin and lymph nodes is most often not difficult, then examination of the rectum requires appropriate training, both for the doctor (skills) and the woman (body). It also requires special training and a gynecological examination and mammary glands.
Gynecological examination consists of two parts: examination of the external genitalia and vagina using mirrors (1) and manual (bimanual) examination (palpation) of the internal genital organs through the vagina or rectum. When viewed in mirrors, material is taken (excretions, scrapings, aspirates) for various types of research.
Manual examination and its sensitivity
Against the background of modern equipment of offices with ultrasound machines and other equipment, the question arises, how rational is it to conduct a gynecological examination, especially its second part - a manual examination? If an examination of the external genital organs, the walls of the vagina and the external portion of the cervix can show visible changes or deviations from the norm (but not always), then how effective is a manual examination if the internal organs are not visible, but only tangible, and not in all women? In other words, how sensitive are the human hands, combined with the eyes and level of knowledge, in detecting women's diseases?
The answers to these questions are of interest not only to modern women, but also to doctors. In December 2011, an article was published in one of the American professional medical journals on the advisability of a gynecological examination (meaning a manual examination by a doctor). In this country, women are most often examined for cancer of the ovaries and other organs of the reproductive system, when prescribing hormonal contraception, for the detection of sexually transmitted infections, as well as at regular and periodic visits from healthy women. Among doctors, 98% of obstetrician-gynecologists, 90% of family doctors and district therapists, and 54% of internists (doctors for diseases of internal organs) conduct gynecological examinations of women constantly, that is, they have some experience in conducting examinations. Manual examination of the pelvic organs is done more often by female and family doctors.
Interestingly, in the United States, no medical authority or institution recommends manual gynecological examinations of women to detect malignant and other ovarian tumors, but most doctors continue to do them. These studies have shown that the accuracy of manual examinations in relation to the diagnosis of ovarian tumors is extremely low, and the level of false positive diagnoses is 98% (!) Such diagnoses cause great anxiety, excitement, and stress among women. The frequency of other false-positive diagnoses is also not low. Definitely, almost every doctor tries to reinsure himself, rather than miss the disease. But how justified is such a reinsurance if, after the examination, a woman has to go through an additional, often not free, examination, including an invasive one, and most importantly, through additional stress for her body?
So are gynecological (manual) examinations necessary if most doctors don't know how to do them properly? What is the way out: improving the training of doctors and improving their qualifications or abandoning manual examinations and using ultrasound and other diagnostic methods? These questions sound rational, but there are no rational answers to them in any country in the world. Therefore, gynecological examination will remain in the practice of doctors for at least another decade or even longer.
Gynecological examination and infection
How true are the stories about infection with various infections during a gynecological examination? This issue is controversial, despite the modernity of the era and the availability of disposable gloves and tools.
About 20-30 years ago, gloves were almost worth their weight in gold - every doctor or student had one glove, which he used to examine all women in a row. The treatment was very simple: the glove was washed in running water using soap, then dried and wiped with a disinfectant solution, for example, a solution of medical alcohol.
In maternity hospitals, the picture was no better: right in the emergency department, women were often shaved with the same blade, saving on everything. In the era of the economic crisis, even operations were carried out with disposable blades, since there were not enough scalpels. No one in those days seriously sounded the alarm about the transmission of some viral infectious agents.
Later, at the end of the 90s, there were already enough gloves that were quickly torn due to repeated frequent treatments and sterilization. However, no women were examined with the same glove without appropriate treatment and autoclaving. Therefore, the transmission of sexual infections in this way was completely excluded. It is difficult to say how correctly gloves and instruments were processed in all medical institutions - compliance with the rules of sanitation depended, first of all, on the doctor himself. If he did not control the quality of the processing of gloves and tools, then anything could happen.
Modern doctors have everything to conduct a high-quality safe examination of women. In no country in the world, not a single medical institution, with the exception of some private ones, can financially afford the use of disposable "mirrors". Although they are lightweight, made of transparent plastic and easy to use, they are not cheap. The costs of such instruments far exceed the costs of reprocessing and sterilizing multiple traditional metal instruments. Therefore, until now, most institutions around the world use metal tools. After their proper cleaning and heat treatment, there is no risk of transferring any infectious agents.
For bedding pads in modern conditions, disposable paper towels or polyethylene pads are used, so there is no need to bring your own towels, except for those institutions where this has become a requirement.
If you are required to bring your own instruments, ask your doctor which ones (what model, what for, what sizes, etc.) to buy. All commercially available disposable instruments and gloves are non-sterile. They are clean but not sterile. Is it necessary to sterilize them? No, because they did not have contact with sick people, so it is unlikely that there may be any pathogens of infectious diseases on their surface. If the packaging of such instruments is damaged, they cannot be used, despite the fact that the woman herself, for the sake of curiosity, violated the integrity of the packaging. All physicians must adhere to the rule: if a woman brings with her tools that are not factory packed, they must not be used under any circumstances.
Preparing a woman for a gynecological examination
There is no special preparation of a woman for a gynecological examination, but a number of recommendations should be followed. First of all, a woman should not have any sexual intercourse in the vagina the day before the examination.
The intestines should be emptied: if there is constipation, it is advisable to do an enema a few hours before the examination. Taking laxatives is not recommended, as they not only stimulate intestinal motility, but can cause bloating, pain, and discomfort in the lower abdomen, which will create a false picture of symptoms on examination. The absence of fecal masses in the rectum is also important because the body of the uterus can be deviated to one side due to overcrowded intestines, which can be mistakenly called an adhesive process, inflammation, including during ultrasound.
Filling the bladder is important for ultrasound, and for a gynecological examination, on the contrary, it must be emptied. You should not take diuretics - just go to the toilet before the examination.
Many women believe that if they "clean it well inside there," then they will do a great service to the doctor and themselves. This is not true. No douching before the exam, and no douching at all!
Firstly, the tip can damage the cervix, which will seem like erosion to the doctor (in this case, it will be true erosion, which will heal by itself) and he will immediately send the woman for examination. Secondly, by washing out all the contents from the vagina, the true picture of the state of this part of the reproductive system is distorted, which can lead to poor-quality smears and erroneous results.
Before examination, it is enough to wash with warm water and neutral (children's) soap. Perfumes and various fragrances, including deodorants, should not be used in the vulvar area, as they can increase secretions, irritate the skin and mucous membranes, and create an unpleasant odor along with vaginal discharge.
Gynecological examination of girls and older women
Modern youth differs significantly from other generations in their attitude to sexual life, and many girls have their first sexual contacts at the age of 9-11. In addition, young people actively practice anal and oral sex, when virginity can be preserved for years.
Of course, when doctors ask girls about sexual intercourse, they mean vaginal intercourse. It is very rare that doctors ask about other types of sexual activity, although this is important to know because various infections can be transmitted through anal and oral sex too.
Inspection of the vagina and cervix in the mirrors of virgins is not carried out. Manual examination of the pelvic organs is performed through the rectum. This is often a painful and unpleasant procedure, and it is not so easy to identify the pathology with it, however, an experienced doctor will make such an examination with the least discomfort for the woman. Also, in such cases, it is advisable to conduct an ultrasound scan.
Older women should also be viewed with caution. The problem is not so much in the narrowing of the vagina (it practically does not change), but in the fact that the skin at the entrance to the vagina and the mucous membrane of the vagina become easily vulnerable and vulnerable due to a smaller amount of secretions, which causes pain and discomfort. In such women, special lubricants (moisturizers) can be used during the examination (usually after the necessary material has been taken for analysis).
Gynecological examination performed by a male doctor
The question of a male gynecologist, that is, when a female doctor is a man, is interesting and, probably, worries more young girls than older women, mainly because of shame.
Abroad, male gynecologists are not recommended to conduct examinations of patients without a witness, that is, a nurse or midwife. There are already many lawsuits in history where doctors, especially gynecologists, have been accused of sexual abuse and violence. The vast majority of these accusations were false, but discussions and slander have negatively affected the reputation of many doctors. It is important for the doctor's and women's interests that a midwife or nurse, or at least a colleague, be present in the examination room.
Gynecological examination and strangers
Speaking of gynecological examinations, one cannot fail to recall an important rule: all examinations of women should be carried out in the absence of strangers in the examination room. What does it mean? That there can't be two patients in the same office at the same time, no one else but a doctor and a nurse or a midwife. This ensures the confidentiality of information, as well as showing respect for the patient, especially if the woman needs to undress for the examination.
Abroad, the presence of technical personnel (nurses, cleaners) during the examination is prohibited, unless urgent cleaning is required in the place where the examination is carried out, for the safety of the woman and the doctor (for example, wipe the floor dry from blood or other liquid, remove glass fragments and etc.). Colleagues and other hospital staff are not allowed to enter the doctor's office during the patient's appointment, except when these people are invited with the consent of the patient by the doctor to resolve some controversial or important issues (for example, to clarify the diagnosis).
The presence of relatives during the examination is possible only after the consent of the woman, but most doctors do not practice the presence of an outsider, even a relative, in the office. This is due to the fact that sometimes it is necessary to ask questions that a woman in the presence of another person can answer falsely. At the same time, between relatives (spouse, woman and mother or mother-in-law, mother and daughter, etc.) there are often relations of a tyrant-victim, that is, elements of verbal (verbal), moral or emotional violence and abuse. Therefore, the presence of relatives in their personal interests is inappropriate. The doctor has no right to disclose the results of the examination and examination to other people without the consent of the patient.
What to bring for inspection
Very often, women ask what they need to take with them to the examination. Unfortunately, the answer "The main thing is that you bring yourself, an ID card, and everything else is not so important" is impossible. Now a visit to a doctor or a stay in a hospital, not to mention any surgical intervention, costs a resident of Ukraine and other post-Soviet countries such astronomical sums that even an American or a European could not dream of, given the high cost of their health care. Each institution has its own requirements, so it is best to call in advance and clarify what you need to take with you for an examination with a doctor.
The quality of a woman's examination depends entirely on the doctor - on his awareness of how this examination will be positive or negative for his patient. Even if any problems are identified, a woman can leave the doctor’s office with hope for the best, and vice versa (which happens most often in reality), she can leave depressed, intimidated, in despair, fear, which will negatively affect her future life, and can also cause the suffering of her neighbors.
Examination of girls by a gynecologist is carried out at 3, 7, 12, 14-17 years (after 14 years - annually) - before entering kindergarten, school, and then after graduating from elementary school and in adolescence. In addition, when symptoms of trouble appear on the part of the organs of the reproductive system, an extraordinary consultation of a pediatric gynecologist is prescribed, during which the doctor not only determines the state of the child's health, but also prescribes the necessary treatment.
Organization and legal framework
An examination by a pediatric gynecologist can be done at a polyclinic at the place of residence for free or on a commercial basis in a private medical institution that has the appropriate license and specialist. It is carried out on the basis of the order of the Minister of Health No. 1346n dated December 27, 2012 “On the procedure for passing medical examinations by minors”. If the institution does not have a specialist "children's gynecologist", a medical organization cannot replace him with a doctor of another specialty.
Parents are informed about the medical examination at least 5 days in advance and take written consent to conduct it. In this case, the legal representative of the child (father, mother or guardian) may be present during the procedure itself in the doctor's office.
Parents or guardians may refuse to have their child pelvic exam based on federal public health law. In this case, the child will not be able to refuse admission to kindergarten or school.
In Russia, a medical policy is required to undergo a medical examination by a gynecologist.
If a girl has reached the age of 16, she gives written consent to a consultation with a gynecologist herself, while parents are not required to notify about this procedure, and even more so about its results. Most likely, a 15-year-old girl without parents will not be accepted by a pediatric gynecologist, and an “adult” will not be examined at all, because he does not have the right to diagnose and treat diseases in children.
All data is entered into an outpatient card or special forms before admission to a kindergarten, school, or dispensary observation documents. They constitute a medical secret, and no one can get acquainted with these data without the consent of the parents or guardians of the child.
There is an exception to this rule. According to the order of the Ministry of Health of May 17, 2012 No. 565n, if the doctor during the examination reveals signs of illegal, violent acts against the girl, he will be obliged to report this to the internal affairs authorities.
If a girl was examined by a gynecologist for some reason, and there is information about this in her medical record, these results are “counted” if they are no more than 3 months old.
Indications for visiting a doctor
Scheduled preventive examinations are carried out for the early detection of serious health problems, which can then lead to severe reproductive disorders and even. Therefore, there is no need to abandon them. Such examinations are completely painless, the gynecological chair has been used since adolescence.
In addition, it is necessary to visit a pediatric gynecologist if the girl has complaints:
- itching and burning in the perineum;
- discharge from the genital tract, stains on linen;
- pain in the lower abdomen, accompanied by fever;
- lack of menstruation at 15-16 years;
- the girl has too heavy, painful periods, lasting 7 days or more;
- the appearance at the age of 11-12 of signs of male pattern hair growth, acne, insufficient development of the mammary glands;
- accelerated sexual development, the appearance of the first menstruation before 11 years.
The main diseases detected by a pediatric gynecologist
Examination of girls by a gynecologist in kindergarten and subsequent dispensary observation is carried out to identify the following groups of diseases:
- inflammatory diseases of the pelvic organs;
- non-inflammatory diseases of the genital organs;
- breast disease;
- congenital anomalies in the development of the genital organs.
At a later date, premature sexual development or its delay is additionally diagnosed, as well as a violation of the rhythm and nature of menstruation.
Most often in girls of prepubertal age, vaginal discharge and irritation of surrounding tissues are detected. Such symptoms account for up to 70% of all visits to a pediatric gynecologist about the disease. Another most common problem is parents' concerns about the normal structure of the genital organs.
Non-infectious vulvovaginitis
Usually this disease is caused by contact dermatitis, that is, skin irritation under the influence of detergents. There is reddening of the skin, in rare cases, vesicles and itching are formed.
A common cause is poor perineal hygiene. This reveals redness and swelling of the labia majora. Sometimes the vulva shows remnants of white discharge or even fecal matter. In more severe cases, scratching appears, which can become a gateway for a secondary bacterial infection.
A rare but serious cause of noninfectious vulvovaginitis in children is lichen sclerosus (lichen). It is accompanied by itching, irritation, soreness, bleeding, impaired urination and pain during defecation. A characteristic feature is white spots on the skin, which takes on the appearance of parchment paper.
When a foreign body enters the vagina, for example, a piece of toilet paper, bloody, purulent discharge with an unpleasant odor, irritation of the vulva may appear.
Infectious vulvovaginitis
Any cases of genital tract infections should alert the doctor to child abuse. This requires the diagnosis of gonorrhea, chlamydia, trichomoniasis, human papillomavirus, HIV infection and infection with the herpes simplex virus. In children under 3 years of age, the source of chlamydia and the papillomavirus may be transmission from the mother during childbirth, even if the woman did not know about the presence of such a disease in herself.
Infectious vulvovaginitis is accompanied by redness and soreness of the skin. Vaginal discharge is yellow-green in color and may be purulent. The disease can occur against the background of a cold, and in this case it is caused not by sexual pathogens, but by streptococci, meningococci, Haemophilus influenzae, staphylococci and pneumococci.
Scratching and secondary infection can be caused by pinworms.
Anatomical changes
Often parents turn to a gynecologist with complaints about the abnormal structure of the external genitalia in little girls. In this case, the doctor conducts a careful external examination, during which he can identify such frequent pathologies:
- infection of the hymen;
- prolapse of the urethra;
- vaginal tumor.
In such cases, surgical correction of the detected defects may be necessary.
Preparing for an inspection
A child at 3 years old usually does not need to explain anything for a long time. It should only be said that they will go to the doctor with their mother, as usual. In the absence of complaints, the examination is limited to external, that is, the doctor visually assesses the structure of the external genital organs and the absence of signs of inflammation.
How to prepare a girl 6-7 years old and older for a gynecological examination?
It is important to remain calm and confident - by the age of 7, the child often does not yet experience any embarrassment and will not notice an “uncomfortable” topic.
The first visit to the gynecologist by a teenage girl is often remembered for a lifetime. Therefore, the mother needs to be explained what will need to be done before (urinate in advance, clean the perineum with a damp cloth) and what will happen during the examination.
Examination by a gynecologist usually does not cause psychological trauma. Parents should not focus on going to the doctor as something unusual or even more shameful. More often the girl worries more in advance than after the visit.
How is the inspection going?
Stages of implementation:
- A conversation during which, in a calm, friendly tone, the doctor asks questions to the little patient and her mother about the developmental features of the child, any complaints or abnormalities in the development of the genital organs. At the same time, psychological contact with the patient is being established.
- Examination of girls before the onset of puberty is usually carried out in the supine position on the couch. The child needs to remove all clothes below the waist, and also lift the edge of the blouse or T-shirt over the stomach. Then the girl lies down on the spread diaper.
- The doctor feels her stomach, then asks to bend her knees - this is done either by the girl herself, or by her mother, who is nearby. The doctor examines the external genitalia.
This concludes the inspection. Only in rare cases, for example, if anomalies of sexual development are suspected, the doctor performs a rectal examination of the uterus and appendages, inserting a gloved finger into the rectum, and prescribes other research methods, in particular, ultrasound.
In girls, it turns out whether menstruation has begun, what is the duration of the cycle, whether there are painful sensations. If (the first menstruation) has already passed, a menstrual calendar should be taken to the appointment, which every girl and woman should keep, marking the days of menstrual bleeding in it.
Adolescents who have already had their first menstruation are examined on a gynecological chair. The doctor always asks if the girl is sexually active. If the answer is negative, he conducts a rectal examination, probing the uterus and appendages through the anterior abdominal wall, on the one hand, and the wall of the rectum, on the other. This manipulation is painless, although unpleasant.
In case of pronounced inflammation, the gynecologist can take vaginal swabs even from a virgin. There are always holes in the hymen through which blood is released during menstruation. Through one of them, the doctor carefully inserts a thin probe under visual control and makes a smear. In this case, the hymen is not damaged.
If necessary, a special children's vaginal speculum can even be inserted through such an opening to assess the condition of the vagina and cervix. Of course, this is not used during the medical examination. But if the doctor suspects a serious disease of the reproductive system, for example, a tumor, such an examination will be carried out. The integrity of the hymen is not violated.
If a girl is sexually active, she is examined in the usual way - vaginally, as well as with the help of mirrors.
In addition, the condition of the mammary glands and secondary sexual characteristics, in particular, pubic hair, is necessarily checked. Inconsistency with their norm indicates a delay in puberty, which is often caused by serious endocrinological diseases. Only their timely diagnosis will help the girl to conceive and bear a child in the future. Therefore, you should not refuse gynecological examinations in adolescents, because at this time the girls are already embarrassed to talk about these topics with their mother.
Perhaps there is not a single woman who does not know what a gynecological examination is.
Representatives of the fair sex get acquainted with him, starting from the school bench, with the exception of a preventive examination by a gynecologist of girls of preschool age. All these are preventive measures aimed at early detection of the pathology of the reproductive system.
Visiting a gynecologist requires not only moral preparation. All girls and women are recommended to carry out hygienic treatment of the external genital organs, change worn underwear to clean ones.
Where does the inspection start?
A gynecological examination begins with a conversation between the doctor and the patient. The gynecologist finds out the reason why the woman was in his office, clarifies the complaints. A detailed collection of a gynecological history is carried out: at what age did menstruation begin, how do they proceed (soreness, amount of discharge, regularity, etc.), the date of the last menstruation is specified, and also the woman gave birth and how many times, whether medical abortions were performed, if yes, for what reason and how many times. In addition, the gynecologist asks questions of an intimate nature: does a woman have a sexual life, in what ways is she protected from unwanted pregnancy, is there a permanent sexual partner,
Further, the simplest instrumental studies can be carried out to measure height, weight, and blood pressure indicators. Pregnant ladies determine the size of the pelvis, measure the circumference of the wrist (to calculate the Solovyov index).
After determining the routine indicators, the gynecologist proceeds to examine the mammary glands to exclude seals. It is much better if you entrust the examination of the mammary glands to a specialist mammologist.
Examination on a gynecological chair
Then, the woman undresses to the waist and climbs into the gynecological chair for further examination.
Initially, the external genitalia are examined to identify the following changes.
- Anogenital warts (broad and genital warts). Detection of wide warts may indicate infection with syphilis, which will require confirmation by specific blood tests. Genital warts often have a viral origin.
- Eruptions. For example, small itchy blisters indicate the presence of the herpes virus.
Anomalies in the development of the external genital organs. The presence of congenital anomalies in the development of the genital organs is more typical for girls in the first years of life. Often they are found even in the maternity hospital. If for some reason the anomaly was not noticed, then its identification falls on the shoulders of a pediatric gynecologist who examines the girl for the first time at 9 months, then when she enters kindergarten, school and at the beginning of puberty. Multiple examinations by a pediatric gynecologist reduce to 0 the detection of congenital anomalies in the development of the external genital organs in women of reproductive age.
- Irritation of the skin of the external genital organs. It can be caused by pathological vaginal discharge (inflammation of the vulva, thrush, trichomoniasis, gardnerellosis, and others).
It's important to know! Healthy daily vaginal discharge is not noticeable to a woman. They are not accompanied by itching, discomfort and irritation in the vulva.
- . Starting from the 3rd degree, ptosis of the uterus is accompanied by the appearance of parts of the uterus from the genital gap. At 2 degrees, this occurs when straining. Omission of the 1st degree is not accompanied from the genital gap.
- The color of the mucous membranes of the genital organs is assessed. With the onset of pregnancy, the mucous membranes acquire a cyanotic (cyanotic) color, which is associated with congestion in the pelvic area.
- The type of location of the hairline on the pubis. In modern women, this is difficult, since many representatives of the weaker half of humanity shave off their pubic hair.
The female type of pubic hair has the appearance of a triangle. The arrangement of hair according to the female type can be disturbed by hormonal disorders (virile syndrome).
After a visual examination of the external genital organs, the doctor proceeds to a vaginal examination, which is carried out using mirrors.
Mirrors can be metal reusable and disposable plastic. After the examination, both of them are soaked in a disinfectant solution, after which the metal mirrors are sent for sterilization, and the mirrors made of plastic are disposed of.
The size of the mirror is selected individually, taking into account whether the woman gave birth or not, whether she has an active sex life, and the age of the patient is not ignored.
After the introduction of the mirror, the walls of the vagina are examined, the condition of the vaginal vessels is assessed, the nature of the discharge is assessed. Detected pathological discharges are taken for microscopic examination.
There should be no formations on the walls of the vagina, for example,.
When viewed with the help of mirrors, swabs are taken for the microflora from the posterior fornix of the cervix and the external uterine os. If any suspicious collections of secretions are found, the smear is taken predominantly from this area.
Additionally, a smear is taken from the urethra.
Next, the cervix is examined. Its color is evaluated (during pregnancy, the neck has a bluish color), consistency, leukoplakia. The shape of the external os of the uterine cervix is determined. If a woman gave birth, the shape of the external os is slit-like. Women who have not given birth have an external uterine os of a rounded shape.
It's important to know! The doctor uses a mirror only in women who are sexually active. Vaginal examination in virgins can be replaced by an examination of the internal genital organs through the rectum.
What's next?
A gynecological examination does not end with an examination using mirrors.
After removing the mirror from the vagina, the doctor conducts a manual examination of the internal genital organs (bimanual examination).
2 fingers of the left hand (middle and index) are inserted into the patient's vagina. At the same time, the uterus is palpated through the anterior abdominal wall with the free right hand. The mobility of the uterus, its position, consistency, size, the presence of volumetric formations in the uterine cavity are determined. In pregnant women, the uterus has a soft texture.
Women who have given birth have a uterus with greater mobility than women who have not given birth. But even in women who have given birth, uterine mobility has its limits. Excessive mobility of this organ may be a sign of its omission.
Not only the uterus undergoes a bimanual examination, the ovaries are no exception. During palpation, the doctor evaluates the consistency, size, mobility, and pain of the ovaries.
An increase in the size of the ovary can talk about or neoplasms. In pregnant women, it often occurs, which does not require treatment, but is of considerable size and can be determined by palpation through the anterior abdominal wall.
Interesting video:
Restriction of ovarian mobility occurs with.
Bimanual gynecological examination is normally painless. Any pain is a sign of the presence of pathology. For example, the detection of a round painful cord near the uterus indicates the development of salpingitis (inflammation of the fallopian tubes). Healthy tubes of the uterus are not determined by palpation.
Not determined by bimanual examination and ligaments of the uterus, which are also examined. The exception is the round ligament of the uterus, which can be determined during pregnancy.
The examination of virgins is carried out through the rectum. To do this, the finger of the left hand, lubricated with vaseline oil, is inserted into the rectum, and the right hand is palpated through the anterior abdominal wall. During a rectomanual examination, the same organs are palpated as during a bimanual examination through the vagina. Their sizes, a consistence, mobility, morbidity are defined.
Sometimes, to clarify the size and location of pathological formations in the vaginal wall, a rectovaginal research method is used, when the index finger of the left hand is inserted into the vagina, and the middle finger into the rectum.
After the end of the gynecological examination, the doctor may additionally prescribe blood and urine tests, as well as an ultrasound examination to verify the diagnosis and plan further treatment tactics for the patient.
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