A comprehensive clinical examination is the basis for selecting further diagnostic steps:
- General physical examination – including blood pressure, pulse, body weight, height [obesity (overweight)]; furthermore:
- Inspection (viewing).
- Skin and mucous membranes [drying of the skin (xeroderma; xerosis cutis) with wrinkling?; regression of hair in the frontotemporal area (receding hairline) and in the genital area?, increase in sebaceous gland activity with consecutive seborrhea in the facial and head area?]
- Abdominal wall and the inguinal region (groin area).
- Inspection (viewing).
- Gynecological examination
- Inspection (speculum)
- Vulva (external, primary female reproductive organs) [fluorine/discharge?, color?, foetor/odor?, inflammation?, vesicles?, coating?, kraurosis vulvae/shrinkage?, tumor?]
- Vagina (vagina), if necessary vaginal cytology to assess the hormonal status [blood?, fluor vaginalis / discharge?, color?, foetor?, mucus?, vaginal dryness?; in case of attempted pressing, if necessary incontinence problems / involuntary discharge of urine (in about 60-70% of cases is a stress incontinence (formerly: stress incontinence))].
- Cervix uteri (cervix), or portio (cervix; transition from the cervix (cervix uteri) into the vagina (vagina)), if necessary, taking a Pap smear (for early detection of cervical cancer) [blood?, ectopy (easily injured cylinder epithelium on the surface of the cervix)?, fluorine?, color?, foetor?, mucus?]
- Palpation (bimanual; palpation with both hands) of the internal genital organs.
- Cervix uteri (cervix) [dolence/pain with movement?, cervical sliding, wiggling, venting pain?]
- Uterus (uterus) [anteflexed/angled forward, normal size for age?, no tenderness?, difficult to move?, fixed?, displaced?]
- Adnexa (appendages of the uterus, i.e., the ovary and uterine tube). [free?, palpable resistances in the small pelvis in the adnexal area?]
- Parametria (pelvic connective tissue in front of the cervix to the urinary bladder and on both sides to the lateral pelvic wall) [free?, pressure dolence?, resistance?]
- Pelvic walls [free?, resistance?]
- Douglas space (pocket-like bulge of peritoneum (abdominal wall) between rectum (rectum) posteriorly and uterus (uterus) anteriorly) free?, resistance?]
- Digital rectal examination (DRU): examination of the rectum (rectum) and adjacent organs with the finger by palpation [free?, mucus?, blood?, tumor?]
- Inspection of the mammae (breasts), right and left; nipple (breast), right and left, and skin [unremarkable?, skin retractions (besodners when arms are raised)?, redness?, swelling?]
- Palpation of the mammae, both supraclavicular pits (upper clavicular pits) and axillae (axillae) [inconspicuous?, resistance/tumor/nodes?, dolence?,orange peel?) secretion/blood secretion from the nipple? Lymph nodes palpable?]
- Inspection (speculum)
- Health check respectively anti-aging check.
Square brackets [ ] indicate possible pathological (pathological) physical findings.