How to do a pelvic organ examination

For women, pelvic examination is very important. The pelvis is an organ prone to infection and is often damaged by bacteria, which often cause pelvic inflammatory disease, vaginitis and other diseases. Therefore, it should be examined in time. There are many methods of examination, including vulvar examination, vaginal examination, etc. Through a good examination, once a problem occurs, it should be treated in time.

How to do a pelvic organ examination

1. Vulvar examination

Observe the development of the vulva, the amount and distribution of pubic hair. In a normal vulva, the pubic hair is distributed in a triangular shape with the tips pointing downward. There are no ulcers, dermatitis, growths or hypopigmentation in the perineum. The mucosa around the urethral opening is light pink and free of growths. Married women have old cracks in their hymen, and pregnant women have old cracks in their hymen and perineum, or there may be incision scars in the perineum. If necessary, the doctor will ask the patient to hold his breath and look for bulging of the anterior and posterior vaginal walls, uterine prolapse, or urinary incontinence. Any abnormalities will be recorded in detail.

2. Vaginal examination

Examination with a speculum: Be gentle and try to avoid bleeding caused by friction. The normal vaginal wall mucosa is light pink in color, with wrinkles, and without ulcers, growths, cysts, vaginal septum, double vagina or other congenital malformations. Normal vaginal discharge is egg white-like or white paste, has no fishy smell, and is in small amounts, but increases during ovulation and pregnancy. If there are abnormalities, the patient may experience local itching, burning sensation, etc. If there is abnormal leucorrhea, the secretions can be removed at this time for smear testing for Trichomonas, Candida, Gonorrhea and clue cells, and bacterial culture can be performed if necessary. Leucorrhea is a mixture of vaginal mucosal exudates, cervical and endometrial gland secretions, and its formation is related to the action of estrogen.

In general, the cleanliness of leucorrhea can be divided into 4 levels:

Grade I: A large number of vaginal epithelial cells and vaginal bacilli are seen under the microscope.

Grade II: Vaginal epithelial cells, a small amount of white blood cells, some vaginal bacilli, and a small amount of miscellaneous bacteria or pus cells are seen under the microscope.

Grade III: A small amount of vaginal bacilli, a large number of pus cells and miscellaneous bacteria are seen under the microscope.

Grade IV: No vaginal bacilli are seen under the microscope, and except for a small amount of epithelial cells, there are mainly pus cells and miscellaneous bacteria.

Note: Grades Ⅰ to Ⅱ are normal, and grades Ⅲ to Ⅳ are abnormal leucorrhea, indicating vaginal inflammation.

3. Cervical examination

A normal cervix has bulges around the periphery and a hole in the middle. The shape of the navel for non-pregnant women is round, while that for pregnant women is "I"-shaped, tough, flesh-red, and has a smooth surface. If the examination is normal, it means that it is light, of medium quality, without itching or pain, etc. If abnormalities are found, the degree of erosion (mild, moderate, or severe), the degree of cervical hypertrophy, and the size and location of the growth will be described in detail. At this time, a cervical cancer prevention smear cytology examination can be performed. This is the main method of cancer prevention screening and is of great value in diagnosing cervical precancerous lesions and early cervical cancer.

4. Examination of the uterus and appendages

The examiner puts on gloves, applies lubricant on the index and middle fingers, and then gently inserts two fingers or one finger into the vagina along the back wall through the vaginal opening. The other hand cooperates with the examination on the abdomen. This is called bimanual examination. Bimanual examination is the most important part of the pelvic examination. The purpose is to palpate the vagina, cervix, uterus, adnexa, uterine ligaments and parauterine connective tissue, as well as other organs and tissues in the pelvic cavity for abnormalities. The normal uterus is inverted pear-shaped, 7 to 200px long, 4 to 125px wide, 2 to 75px thick, of medium hardness and good mobility. The ovaries and fallopian tubes are collectively called "appendages" and feel slightly sore and swollen when touched. Normal fallopian tubes cannot be palpated. If the patient feels pain when the cervix is ​​pushed upward or to the sides, it is called cervical motion tenderness, which is a manifestation of lesions in the pelvic organs. If included, attention should be paid to the location, size, shape, mobility, relationship to the uterus, and presence or absence of tenderness.

Triple examination: a combined examination of the abdomen, vagina and rectum, which is a supplementary examination to the bimanual examination. It can be used to understand the size of the retroverted and retroflexed uterus; whether there are lesions in the posterior uterine wall, rectouterine pouch or uterosacral ligament, especially the infiltration range of the cancer, and whether there are lesions in the vaginal rectal septum, in front of the sacrum or in the rectum.

Rectal-abdominal examination: Suitable for patients with no sexual history, vaginal atresia or other reasons that make bimanual examination inappropriate.

This is a very comprehensive pelvic examination. During the actual examination, the doctor will formulate the examination items according to the needs of the person being examined. We should accumulate more knowledge in this area in our daily lives, which is very important for our physical health and disease prevention.