Gynecological examination

A visit of an obstetrician / gynecologist always begins with a patient interview and interview. Therefore, it is better for a woman to choose a doctor with whom she will not hesitate to discuss intimate issues concerning sexuality, contraception and pregnancy. All the information you said is confidential, the doctor will discuss with you your problems and keep everything secret.

The survey starts with finding out the reasons that led to the woman's treatment to the gynecologist. Then the doctor asks about the menstrual function: the age at which the first menstruation was, the regularity and duration of the cycle, the duration and volume of menstrual bleeding, the date of the last menstruation. A woman should expect questions about the earlier transferred gynecological and venereal diseases, the number of births and abortions, the method of protection from pregnancy, which she currently uses, and enjoyed earlier. It also asks about the existing diseases of internal organs, surgical operations, bad habits: smoking, drinking alcohol, drugs. All these questions are asked not for the sake of interest, but to facilitate the diagnosis.

After the survey, the gynecological examination itself begins, which begins with examination of the mammary glands. The doctor assesses the condition of the skin, nipple, lymph nodes in the armpit, feels the gland to identify seals, nodes, secretions from the nipples.

The study of the genitals is performed by a doctor in the position of a woman on a gynecological chair. Before the examination, it is necessary to empty the bladder and rectum. The doctor conducts the examination in sterile gloves.

The study begins with an examination of the external genital organs: the doctor evaluates the skin and mucosa of the large and small labia, the clitoris and the external opening of the urethra.

After the doctor begins to examine the mirrors, which is of great importance in diagnosing diseases of the vagina and cervix. Nowadays, more and more often women use individual sets for gynecological examination, which includes a napkin, a disposable vaginal mirror and spatula for taking a smear. Sets are sold in pharmacies and are very convenient to use. The procedure for examining the gynecological mirror can be somewhat unpleasant, but not painful. The mirror is inserted into the vagina in a closed state, and then its valves are opened and fixed with the aid of a lock. At the same time, the vaginal walls and the vaginal part of the cervix become readily available for examination. The doctor assesses the condition of the vaginal mucosa, the nature of the discharge, the size and shape of the cervix, the external opening of the cervical canal. After the examination, as a rule, swabs are taken: bacteriological and cytological.

Bacterioscopic examination

This is a study of a smear from the vagina and cervix under a microscope. In the smear, the number of white blood cells is counted (more than 10 indicates the presence of infection) and are looking for pathogens of this infection. Actually a smear can detect fungi (thrush, candidiasis), "key cells" (bacterial vaginosis, gardnerellez), change in normal flora, trichomonads (causative agents of trichomoniasis) and gonococci (causative agents of gonorrhea). If the smear shows the presence of infection (increased number of leukocytes), but does not identify the pathogen, bacteriological culture is shown. Sowing is carried out in order to identify the causative agent of the infection and its sensitivity to antibiotics. Allocations from the vagina and canal cervix are taken with a stick with a sterile cotton swab, placed in a sterile tube, and the material is sent to the laboratory.

Cytological examination

Obligatory stage of diagnosis of cervical pathology. Even if nothing bothers you, and the unaided cervix seems unchanged, a woman should regularly (every year) undergo a cytological examination of the cervical scraping. Cytology is the science of the cell. In the cytological study, the features of the structure of the cells of the cervical surface are studied. This study is conducted for the purpose of early diagnosis of cervical cancer. The smear is taken with a special spatula from the cervical canal, then it is dyed and examined under a microscope, looking for atypical cells that appear in women with malignant degeneration of the cervix before the appearance of changes in the mucous membrane of the cervix.

The diagnosis of the cytologist can, sound so:

• I type - unchanged epithelium.
• I type is an inflammatory process.
• II b type - proliferation, metaplasia, hyperkeratosis.
• III a type - mild dysplasia of the epithelium against a background of benign processes.
• III b type - marked dysplasia of the cervical epithelium against a background of benign processes.
• IV type - suspected malignant process, the possibility of developing cervical cancer.
• V type is cancer.
• VI type - smear uninformative (material taken incorrectly).

When receiving smears II-III b, women are prescribed additional examination and treatment, if a smear of IV-V types is obtained, the patient is referred to a doctor oncologist. If you receive a non-informative result, the smear repeats.

After taking smears, the mirror is removed from the vagina, and the doctor proceeds to a manual vaginal examination. The study is carried out this way: the forefinger and the thumb of the left hand, the doctor dissolves the small lips of a woman, and the middle and index fingers of the right hand inserts into her vagina. Then the doctor's left hand is mixed on the patient's stomach and gently presses on him to meet the fingers inserted into the vagina. In this way the doctor first touches the uterus, determines its size, position, slope, density, soreness, then the ovaries. When you feel the ovaries, the doctor presses harder on the front wall of the abdomen, since the ovaries are small and located deeper, a woman may experience slight discomfort in this part of the study. Manual vaginal examination is difficult for obesity, patient stress, resulting in pain with inflammation of the genitalia or fear of self-examination.

Finally, the examination is completed by rectal examination. It helps to get an idea about fiber around the vagina and rectum, assess the condition of the rectum. This is the only possible way to examine patients who do not live sexually.