A comprehensive clinical examination is the basis for selecting further diagnostic steps:
- General physical examination – including blood pressure, pulse, body weight, height; further:
- Inspection (viewing).
- Skin and mucous membranes
- Abdominal wall and inguinal region (groin area).
- Inspection (viewing).
- Gynecological examination (with empty bladder) – it is checked whether the uterus (uterine) and vagina (vagina) have lowered (descensus uteri et vaginae) as a result of childbirth, heavy physical labor or congenital connective tissue insufficiency (connective tissue weakness), or if they step deeper when pressing, or if there is possibly a hormone deficiency. The muscle strength of the pelvic floor is also tested. Furthermore, in the case of urinary incontinence in old age: urethral calibration (measurement of the degree of narrowing of the urethra).
- Inspection (examination with separate specula (gynecological examination instrument that, by spreading the two blades, allows the vagina (sheath) to unfold) for specific assessment of the different vaginal compartments: anterior, middle compartment, posterior).
- Vulva (external, primary female sex organs) [atrophy sign/hormone deficiency atrophy, skin irritation, skin infection].
- Vagina (vagina) [Descensus uteri et vaginae; or evidence of the deep-penetration when pressing attempt; possibly also prolapse / outflow of the uterus from the vagina, fistula openings]
- 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).
- Palpation (bimanual; palpation with both hands) of the internal genital organs.
- Cervix uteri (cervix of the uterus)
- Uterus (uterus) [Normal: anteflexed/angled anteriorly, normal size, no tenderness; descensus uteri et vaginae; or evidence of depression when pressed].
- Adnexa (appendages of the uterus, i.e., the ovary and uterine 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].
- Digital rectal examination (DRU; examination of rectum (rectum) and adjacent organs with finger by palpation) to assess anal tone and rectal ampulla and assess perineal skin conditions [Skin irritation?].
- Inspection (examination with separate specula (gynecological examination instrument that, by spreading the two blades, allows the vagina (sheath) to unfold) for specific assessment of the different vaginal compartments: anterior, middle compartment, posterior).
- Urologic/andrological examination
- Inspection and palpation (palpation) of the abdomen (belly), inguinal region (groin region), etc.
- Inspection and palpation of the genitals (penis and scrotum; assessment of pubescence (pubic hair), penis (penis length: in flaccid state between 7-10 cm; presence of: Indurations (tissue hardening), anomalies, phimosis / foreskin constriction?) and 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)).
- Neurological examination if necessary – neurogenic lesions? [Disturbance of sensitivity in dermstomen S2-S5 (so-called breeches area)]
- Health check
Square brackets [ ] indicate possible pathological (pathological) physical findings.
