Pathological Breast Milk Discharge (Galactorrhea): Examination

A comprehensive clinical examination 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 and palpation (palpation) of the thyroid gland.
    • Inspection and palpation of the abdomen (stomach), inguinal region (groin region), etc. [Liver cirrhosis – connective tissue remodeling of the liver with resulting functional impairment (due toDifferential diagnoses)]
  • Gynecological examination
    • Inspection
      • Vulva (external, primary female sexual organs).
      • Vagina (vagina)
      • 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 (ovary) and uterine tubule (fallopian tube)) [Normal: free]
      • 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].
    • Inspection of the mammae (breasts), right and left; nipple (breast), right and left; and skin [Normal: unremarkable]; furthermore, note the following: Galactorrhea/diseased breast milk discharge (due to hyperprolactinemia/elevation of blood prolactin levels); hemorrhagic (bloody) galactorrhea; classification of galactorrhea:
      • Grade I: only a few drops are expressible (squeezable).
      • Grade II: at least 1 ml of liquid expressible.
      • Grade III: intermittent spontaneous milk secretion.
      • Grade IV: constant discharge of milk flow.
    • Palpation of the mammae, both supraclavicular pits (upper clavicular pits) and axillae (axillae) [Normal: unremarkable].
  • Urological/andrological examination
    • Inspection and palpation (palpation) of the mammae (mammary glands) [very rarely there is galactorrhea in males; see “Gynecologic Examination” above for classification]
    • Inspection and palpation of the genitals (penis and scrotum; assessment of pubes hair (pubic hair), penis (penis length: between 7-10 cm when flaccid); presence of: Indurations (tissue hardening), anomalies, phimosis / foreskin constriction? as well as the testicular position and size (if necessary by orchimeter); if necessary, the painfulness compared to the opposite side or where is the punctum maximum of pain).
    • Digital rectal examination (DRU): examination of the rectum (rectum) and adjacent organs with the finger by palpation (assessment of the prostate in size, shape and consistency, if necessary, detection of indurations (tissue hardening)).

Square brackets [ ] indicate possible pathological (pathological) physical findings.