The physical examination takes place on the notorious gynecological chair. Even though its shape is rather off-putting and it – esp. The abdominal wall is relieved by the slight elevation of the upper body, making it soft and easy to palpate; the upholstery of the chair, including in the back, counteracts a hollow back and helps the patient to relax as much as possible; and the spreading of the legs gives the physician a good view and palpation of the vaginal region. Immediately before beginning the examination, the patient should visit the toilet once again – the doctor can only assess the region properly if the urinary bladder is empty and therefore small.
Examinations with the speculum
First, the doctor will look for externally visible signs of disease (inspection), such as redness, small pustules, or mucus secretions on the external genitals. Then the doctor will gently spread the labia with two fingers and examine the inside of the vagina (vagina).
He then inserts the speculum (vaginal mirror). This is a metal examination instrument that is used to spread the vagina open slightly so that the vaginal wall and cervix can be assessed and – e.g. as part of the screening examination – smears can be taken for microscopic examination.
Depending on the question, the doctor may use a colposcope in the same examination, a magnifying glass with a light source that is placed in front of the vaginal entrance and with which the internal structures can be assessed at 10-40x magnification.
In special examinations such as the acetic acid test, the mucous membrane is wetted with a tincture and then changes color depending on the type of cell. This makes it possible to visualize suspicious areas particularly well and to take tissue samples from them. Since the size of the speculum is selected according to the size of the vagina, these examinations are usually not painful, at most unpleasant. However, a prerequisite for this is that the patient manages to relax her pelvic floor area.
Palpatory examination
The next step is palpation of the internal genital organs with two hands (“bi-manual”). To do this, depending on the size of the vagina, only the index finger or index and middle fingers of one hand (with glove and lubricant) are inserted into the vagina, and with the other hand the doctor presses against it from the outside above the pubic bone. This allows him to palpate the vagina, cervix, uterus and fallopian tubes between his hands. Many patients find this bimanual palpation unpleasant pressure; however, it should not be painful.
As part of the early detection of cancer, the doctor can also perform a rectal palpation, in which localized tumors can be detected by palpating the rectum. Simultaneous examination of the rectum and vagina with one finger each also allows the retaining ligaments of the uterus and the pelvic wall to be assessed well (bidigital rectovaginal examination).
During pregnancy, the physician can palpate the abdomen from the outside with certain hand grips (Leopold hand grips) and thus obtain various information, e.g. about the position and size of the child. In addition, he also examines from the vagina and – later – from the intestine.
Breast examination (mammadiagnostics).
Part of the gynecological examination, especially with regard to the early detection of cancer, is the assessment of the breasts by means of looking at (inspection) and palpation (palpation). Among other things, attention is paid to the symmetry of the breasts, the skin, the nipples, secretions, lumps or adhesions, lack of mobility when lifting the arms, tenderness and enlargement of the lymph nodes. Imaging procedures such as mammography, ultrasonography, or magnetic resonance imaging may follow as needed.
