A comprehensive clinical examination is the basis for selecting further diagnostic steps:
- General physical examination – including blood pressure, pulse, body weight, height; further:
- Inspection (viewing).
- Skin and mucous membranes
- Abdominal wall and the inguinal region (groin area) [in rare cases: e.g., endometriosis foci on the belly button].
- Inspection (viewing).
- Gynecological examination
- Inspection
- Vulva (external, primary female sexual organs).
- Vagina (vaginal) [in rare cases, detection of endometriosis lesions].
- Cervix uteri (cervix) or portio (cervix; transition from the cervix (cervix uteri) to the vagina (vagina)), if necessary, taking a Pap smear (for early detection of cervical cancer).
- Palpation (bimanual; palpation with both hands) of the internal genital organs:
- Cervix uteri (cervix).
- Uterus (uterus) [Normal: anteflexed/angled anteriorly, normal size, no tenderness].
- Adnexa (appendages of the uterus, i.e., the ovary and uterine tube). [Normal: free; often evidence of cysts/chocolic cyst]
- Parametria (pelvic connective tissue in front of the cervix to the urinary bladder and on both sides to the lateral pelvic wall) [Normal: free; in rare cases endometriosis foci, especially in the posterior vaginal vault, or of the posterior vaginal wall in the case of infestation of the septum rectovaginal/thin connective tissue partition (septum) between the vagina (vagina) and the rectum (rectum)) and the pararectal (“around the rectum”) space with the rectum (“rectum”) connected therein].
- Pelvic walls [Normal: free]
- Douglas space (pocket-like bulge of the peritoneum (abdominal wall) between the rectum (rectum) at the back and the uterus (uterus) at the front) [Normal: free; often endometriosis lesions here, which appear as nodules]
- Digital rectal examination (DRU): examination of the rectum (rectum) and adjacent organs with the finger by palpation [rarely evidence of endometriosis lesions in the rectum / rectum].
- Inspection
- Health check
Square brackets [ ] indicate possible pathological (pathological) physical findings.