Studies
There are various methods of examination of the vagina and its surrounding structures: Manual vaginal examination including colposcopy and smear test, an examination of the Douglas space or a vaginoscopy are performed. A vaginoscopy is an inspection of the vagina with the help of an endoscope, which is an optical instrument (“light tube”) with a connected camera, which enables the “reflection” of hollow organs. This procedure is used either in children or in women with a very narrow vaginal entrance (introitus) or still intact hymen.
Overall, however, this examination method is rarely used. In contrast, the vaginal examination, which is performed by a gynecologist as part of cancer screening, is considered more important. The gynaecologist more or less follows a fixed scheme; at the beginning there is the external examination (inspection) of the pubic hair, skin, vulva, clitoris, labia as well as the entrance to the vagina (introitus) and the exit of the urethra (ostium urethrae).
In addition, patients should press once under the supervision of the doctor to check whether urine is leaking (in the case of stress incontinence) or whether the uterus (uterus) is coming out (in the case of descensus or prolapse). This inspection is followed by an examination of the vagina using special instruments – specula. In this way, the labia can be carefully pushed aside to allow an examination of the vaginal wall and the portio.
The whole procedure can be performed as a simple colposcopy; i.e. the vagina is viewed through a microscope (colposcope) with 6 to 40x magnification. This method is called extended colposcopy if acetic acid or a specific solution (Lugol solution) is additionally swabbed onto the portio to examine the cells for changes. In this procedure, the gynecologist can also use a spatula and brush to take a smear of the portio and cervical canal in order to complete a cytological examination.This is also known as a PAP smear, which is used for the early detection of cancer of the cervix (where polyps may also have occurred as a precursor) (cervical cancer).
A pathogen smear can also be taken if required and if there is clinical suspicion. The final step is the bimanual vaginal palpation, whereby the gynecologist usually inserts two fingers of one hand into the vagina to check the position, shape, size and consistency of the vagina, portio, uterus, ovaries and surrounding structures. With the other hand he palpates the vagina from the lower abdomen.
If necessary, a rectal examination may follow. In addition, an examination of the deepest sac of the peritoneum, the Douglas cavity, through the vagina is possible. The doctor can palpate this space over the back part of the vaginal vault (fornix) and puncture it if necessary. The smear of the vagina shows different findings depending on the time of the female cycle:
- In the proliferation phase preovulatory = many parabasal cells
- At the time of ovulation (ovulation) = many superficial cells
- In the secretion phase postovulatory = many intermediary cells
- In children and postmenopausal = many parabasal cells
