A comprehensive clinical examination (to rule out, for example, cervical cancer (cancer of the uterine cervix), fibroids, endometriosis, cysts, vaginal infections) is the basis for selecting further diagnostic steps:
- General physical examination – including blood pressure, pulse, body weight, height; furthermore:
- Inspection (viewing).
- Skin and mucous membranes
- Abdominal wall and inguinal region (groin area).
- Inspection (viewing).
- Gynecological examination
- Inspection
- Vulva (external, primary female sexual organs).
- Vagina (vagina) [possibly vaginal skin atrophy due to estrogen deficiency (menopause); vaginal mycosis/fungal disease of the vagina]
- Cervix uteri (cervix) or portio (cervix; transition from cervix uteri to vagina (vagina)) [Exclusion of a cervical carcinoma / cervical cancer], 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; in the case of endometriosis, cysts/chocolic cyst may need to be detected here].
- Parametria (pelvic connective tissue in front of the cervix to the urinary bladder and on both sides to the lateral pelvic wall) [Normal: free].
- 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: clear; in the case of endometriosis, endometriosis lesions, which appear as nodules, are often detectable here]
- Digital rectal examination (DRU): examination of the rectum (rectum) and adjacent organs with the finger by palpation [Normal: inconspicuous mucosa].
- Inspection
- Health check
Square brackets [ ] indicate possible pathological (pathological) physical findings.