Examination of the external genital organs in women. II

Examination of the external genitalia. Inspection technique. Examination of the genitals using mirrors. Inspection technique. Mirror of Cusco. Spoon-shaped mirror.

Examination of the external genitalia performed in sterile rubber gloves on a gynecological chair or couch: the woman lies on her back, legs bent at the hip and knee joints and apart; A cushion is placed under the sacrum. The external genitalia are treated with one of the antiseptic solutions. The labia minora are spread apart with fingers II and I of the left hand and the external genitalia (vulva), the mucous membrane of the vaginal opening, the external opening of the urethra, the excretory ducts of the large glands of the vestibule and the perineum are examined.

Research using mirrors. After examination of the external genitalia and the mucous membrane of the entrance to the vagina begin to study with using vaginal speculum(Fig. 4.5).

This research method allows you to identify cyanosis of the cervix and vaginal mucosa, as well as diseases of the cervix and vagina. Can be used casement And spoon-shaped mirrors. Casement mirror is inserted to the vaginal vault in a closed form, then the valves are opened, and the cervix becomes accessible for inspection. The walls of the vagina are examined as the speculum is gradually removed from the vagina. After examining the cervix and vaginal walls, the speculum is removed and a vaginal examination begins.

Gynecology includes a complex of tests and diagnostic methods that every woman will have to undergo more than once. An examination by a gynecologist is especially important for that category of women who suspect they have a gynecological disease, are planning motherhood, or are preparing to become a mother. Let's look at exactly what mandatory tests and studies are included in an examination by a gynecologist, how they are carried out and what they can show.

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External gynecological examination

External examination is a simple but very important gynecological examination, which is carried out both as a preventative measure and for direct diagnosis of pathology (in the presence of characteristic complaints or symptoms). During this examination, the doctor pays special attention to all organs located in the anogenital area - the pubis, external and internal labia, anus. After this, the internal condition of the vagina is assessed (examination of the cervix).

During a superficial examination of the genital organs, the doctor, first of all, focuses on such points as:

• skin condition (dry, oily, greasy, etc.);
• the nature of the hairline (sparse or thick hair, condition of the hair roots, presence of power lines, etc.);
• the presence of bulges or any tumors on the surface of the genital organs;
• redness, swelling of areas of the skin or the entire organ.

During a more detailed examination, the doctor spreads the external labia and conducts a visual analysis of the state of the genital anatomical structures, assessing:

• clitoris;
• inner labia;
• opening of the urinary canal;
• vagina (outside);
• hymen (in teenagers).

During such an examination, the doctor may notice pathological discharge, which will indicate some kind of disorder in the woman’s body. In such a situation, an additional bacterial culture test or smear microscopy is required. This will allow you to accurately determine the presence of the disease and find out its causative agent.

Gynecological examinations for women and girls are different!

Girls also sign up. External gynecological examination for girls who have not begun sexual activity and women who have lost their virginity will vary. There are 3 options for examination: recto-vaginal, vaginal and rectal. As for the first two, they are capable of providing many times more information than the last, but, as you understand, they are not suitable for teenagers.

For an experienced gynecologist, an external examination of the genital organs can provide extensive information regarding the structure and development of the genital organs, diseases associated with changes in the skin and mucous membranes, discharge, etc.

• During an external gynecological examination, hypoestrogenism is easily detected. When it occurs in a woman, the doctor will be able to observe a clear pallor of the labia majora and minora, which is most often accompanied by increased dryness of the mucous membrane of the vagina and uterus.
• Another common pathology that can be identified through external examination is a significant increase in the amount of estrogen in a woman’s body. During the course of such a disease, as a rule, there is an increase in the humidity of the vagina and vulva. Sometimes the mucous membrane changes color.
• The color of the mucous membrane can also indicate pregnancy - the longer the period, the brighter the vaginal mucosa looks. This is due to blood flow and hormonal changes in the body.
• A rare disease that can be detected by external examination of the genital organs is hyperandrogenism. It is usually characterized by a significant increase in the size of the clitoris, and its noticeable distance from the urinary canal (more than 2 cm from its previous location). This pathology may be accompanied by pronounced hypoplasia of the inner labia. Such clinical manifestations of the disease are very similar to the manifestations of a virilizing tumor, which can pose a much greater danger to a woman’s health.
• Condylomas, examination inflammations, injuries to the mucous membrane and genital organs, ulcers, etc. are clearly visible during an external gynecological examination.

Features of examination by a gynecologist after childbirth

If the patient undergoes an external genital examination of the genital organs immediately after childbirth, then the doctor, first of all, pays attention to the structure and condition of her perineum. After childbirth, damage to the pelvic floor muscles or significant stretching of the vaginal walls are often observed.

With such deviations in a woman’s body, the doctor will observe a stable open state of the genital slit. As a result, this feature can lead to prolapse of the uterus from the vagina when it is tense. Violation of the integrity of the pelvic muscles also leads to periodic involuntary emptying of the bladder in a woman - urinary incontinence. In this case, timely action can save you from big problems in the future.

Internal inspection

The subsequent examination is an internal gynecological examination, which is mandatory for all women. It includes a detailed study of the condition of the uterus, cervix, and vaginal mucosa. Upon examination, the doctor sees:

• Discharge . They can be transparent, white, mixed with blood or in the form of pure blood, odorless, odorless, foamy, etc. The gynecologist necessarily takes a smear and sends the analysis for examination.
• Significant anatomical defects of the uterus . Depending on their nature (congenital or acquired), their effect on reproductive function and the possibility of treatment are determined.
• Inflammation, tumor . In addition to changes in the anatomical structure, during an internal gynecological examination, the doctor can visually notice foci of inflammation or small tumors, which clearly indicate serious disorders. However, it should be noted that many symptoms are similar in different gynecological diseases, therefore, to clarify the problem, various tests and additional examination are used, for example, if cancer is suspected, a biopsy will be required.

Previously, it was believed that pathology could be determined simply by discharge. This is how oncology, cervicitis, and benign tumors were calculated. Modern gynecologists prefer to use accurate diagnostics - tests, ultrasound and other methods.

Instruments used by a gynecologist for internal examination

Examination by a gynecologist takes place using special mirrors, which differ in design and purpose.

• Paderson mirror . It is used for those categories of patients who have an active sex life.
• A more versatile mirror is the Cusco mirror. It has a folded shape.
• Grave's Mirror. In fact, it is no different from the Cusco mirror: neither in design nor in efficiency.

All of the above mirrors used for internal gynecological examination are carefully sterilized in special devices - sterilizers. Therefore, when visiting a good clinic, you don’t have to be afraid of picking up an infection. Nowadays there are also disposable mirrors. They are more often used for examining women with a known dangerous infection or for gynecological examination of patients with low immunity. Also, any woman can buy a disposable gynecological kit at the pharmacy and bring it with her.

When performing a procedure for examining the cervix, the doctor selects the smallest speculum and inserts it into the vagina at an oblique angle. Approximately halfway through the length, the mirror is stopped and turned so that the gynecologist can clearly see the surface of the uterus. When the correct angle is achieved, the vaginal gynecological instrument is fixed in the required position. Mirrors are used not only to examine the uterus, but also to perform operations on it.

When examining the vagina from the inside, using a speculum, the doctor evaluates criteria such as:

• general condition (are there any defects in the cover, violation of the integrity of the shell, folds of different sizes, etc.);
• color of walls and mucous membrane;
• changes in vaginal anatomy;
• presence of tumors (of any type);
• shape and size of the cervix;
• the presence of discharge of any character and color;
• the presence of cervical tears, uterine defects.

Using a mirror, the doctor will be able to visually observe multiple polyps. Such formations are removed.

Bimanual examination by a gynecologist

The third type of gynecological examination, which is carried out for every woman, involves palpating formations on the walls of the vagina, uterus and periuterine tissue. You can also evaluate the condition of the uterus itself.

A bimanual gynecological examination is carried out as follows: the doctor penetrates the vaginal opening with two fingers, and with the other hand, from the outside, gradually presses the groin area, pressing the inner walls against the fingers located in the vagina. With the help of this examination, the doctor can easily determine the condition of the woman’s arches (whether they are thickened or, conversely, narrowed).

For a detailed examination of the condition of the uterus, the doctor inserts one hand into the vagina and the other into the anus, pressing the walls of both anatomical passages against each other. This allows the doctor to determine the size and shape of the uterus, as well as the presence of any defects or tumors on it.

Normal indicators of the uterus during examination by a gynecologist

In normal conditions, the length of the uterus is up to 7 cm if the woman was not pregnant. If there has been childbirth, then its length reaches 10 cm. Any deviations in size, both smaller and larger, indicate problems, for example, a tumor, menopause, etc. If a tumor is suspected, a gynecologist necessarily prescribe additional diagnostics to the patient, usually an ultrasound of the uterus. If the ultrasound results show anatomical abnormalities, the diagnosis will be disappointing. You will have to undergo additional examination to determine the type and size of the tumor. The uterus can enlarge in an absolutely healthy woman. This indicates the approach of ovulation or pregnancy.

By the location of the uterus, the doctor can also judge the woman’s health status. Normally, it should be located opposite the entrance to the vagina and located strictly in the center. If, upon examination, its displacement or tilting at any angle is observed, then this may indicate either the presence of a tumor or the occurrence of an inflammatory process. To find out the diagnosis in more detail, the woman will need to undergo a number of additional studies.

In normal condition, the uterus has sufficient elasticity, and may well move slightly in different directions. In cases where a woman has undergone childbirth, the mobility of the uterus increases significantly, and the organ may fall out. This indicates severe damage to the internal muscles of the vagina. If the uterus, on the contrary, is inactive, this is also bad. The patient may, for example, have tissue infiltration or a tumor.

Other female organs examined bimanually

In addition to a gynecological examination of the uterus, during a bimanual examination, the gynecologist also examines the condition of the fallopian tubes and ovaries. Of course, he cannot look inside, but he can feel it. If they are in normal condition, there will be no noticeable deviations. However, if a disease such as sactosalpinx is present, the doctor will feel lumps.

The last organ identified during a bimanual examination is the uterine ligaments. In a normal state they cannot be felt, but in the presence of fibroids they become clearly visible. The exception is pregnancy. If tears or scars are felt on the ligaments, the presumptive diagnosis is parametritis or infiltration.

Recto-vaginal examination by a gynecologist

This type of diagnosis is considered additional and is carried out only in postmenopausal patients or if diseases of the uterine appendages are suspected. In terms of its effectiveness, such a study is close to a bimanual examination.

During a recto-vaginal examination, the doctor examines the internal walls of the vagina, colon and the condition of the genital septum. The examination is carried out as follows: one finger is inserted into the vaginal opening, and the second into the anus. With the help of light pressure, the walls of the two anatomical passages are pressed against each other.

During a recto-vaginal gynecological examination, the doctor can determine the degree of mucous membrane of each membrane, the presence of tumors, and deformities. After the fingers are removed from both holes, the gynecologist examines the gloves for traces of blood, pus, and discharge. With the help of a recto-vaginal examination, if there is a tumor inside the vagina, it is possible to determine whether it belongs specifically to the reproductive system.

Bacteriological examination during examination by a gynecologist

This type of examination by a gynecologist is fundamentally different from all of the above, since the doctor does not study the structure of organs and their appearance, he is interested in the composition of the mucus and flora of the mucous membrane, taken by smear. This analysis provides extensive information about the presence of a particular disease in the patient’s genital area. What is especially important is that the doctor receives information about the pathogen, so he can quickly take effective measures. Another function of bacteriological analysis is to identify the sensitivity of microorganisms to antibiotics. Knowing what can be used to destroy the infection, it will be easy to cope with it.

How a gynecologist takes a smear for examination

To conduct any of the above tests, the gynecologist takes a smear from the subject. A smear can be taken from the vagina, cervical canal, or urethra.

Smear collection is carried out in the following sequence:

• Discharge from the urethra . Before taking a smear, the gynecologist prepares urethra, massaging it for 5 - 10 minutes with one finger from the vaginal opening. Next, an absorbent tampon is inserted for 30 seconds. The immersion depth of a sterile swab is up to 2 cm.
• Vaginal discharge . In this case, no preliminary preparation measures are required - the vagina is always moisturized. The gynecologist collects discharge from the posterior vaginal vault with a special spatula.
• Discharge from the cervical canal . The gynecologist uses speculums to expose the uterus. The surface of the uterus is treated dry with a sterile absorbent swab. After this, a special probe is inserted into the uterus - it collects fluid from the cervical canal.

The resulting material is studied under a microscope. Depending on the symptoms and complaints, the research method is selected.

What does a gynecologist determine in a smear?

During bacterioscopic analysis, the doctor determines:

• Leukocytes . Particular attention is paid to their quantity and concentration. At the first stage of density, the smear will be quite clean, and the number of leukocytes will not exceed 5 pcs. In the second stage, the number of leukocytes is from 5 to 15. At the third stage, the smear is very thick and contains up to 25 leukocytes. In the fourth stage, the number of leukocytes exceeds 25. In the last two cases, the gynecologist prescribes additional tests for the patient, since all signs indicate a strong inflammatory process.
• Microflora. According to the state, the microflora can be bacillary (considered the generally accepted norm, in which the patient does not experience abnormalities) and coccal (clearly indicating the presence of an infection in the body);
• Gonococci, fungi, trichomonas . There will be no pathogenic microorganisms in a smear of a healthy woman, and opportunistic microorganisms (candida fungi, commonly called thrush) do not exceed the norm.

Even this information is enough for an examination by a gynecologist to be considered effective.

Gynecological examination with colposcopy

During this procedure, a gynecologist examines the woman's internal organs - the cervix, vagina and vulva. The examination is carried out using a special device - a colposcope. A gynecological examination with a colposcope is an accessible and informative procedure. The process is absolutely painless.

When colposcopy is prescribed, contraindications

As a rule, examination with a colposcope is recommended every six months, but it is not mandatory for healthy women. Colposcopy is required if significant abnormalities are detected as a result of the analysis of the LBC smear or PAP test.

Colposcopy is also prescribed if:

• warts in the genital area;
• cervical erosion;
• inflammation of the cervix at any stage;
• suspicion of presence cancer in the vagina;
• uterine cancer;
• significant changes in the shape and size of the vulva;
• cancerous tumor on the vulva;
• precancer, vaginal cancer.

There are no contraindications for this study, but the doctor will not do the examination on critical days and during pregnancy unless there are serious indications for this.

The gynecologist will prescribe an examination with a colposcope during pregnancy if the procedure cannot be postponed until the baby is born, due to a serious threat to the health of the expectant mother. Naturally, the examination by a gynecologist will be carried out with special care so as not to provoke a miscarriage.

Preparation for colposcopic examination

Before performing a colposcopy, the gynecologist will give the following recommendations:

• Abstinence from sexual activity, even with a regular partner, for at least three days before the study;
• If there are any diseases or inflammatory processes on the genitals, the woman is strictly recommended to refrain from treating them with suppositories and other vaginal remedies. Treatment can be continued after a gynecological examination.
• If you are hypersensitive to pain, you can take it before the examination. painkiller tablet. Your doctor will prescribe pain medication.

As for the date of appointment for colposcopy, it is determined solely by the gynecologist.

How is a gynecologist examined with a colposcope?

Colposcopy is a routine gynecological examination with enhanced imaging. It is carried out in a completely non-contact way, using a modern device with a built-in microscope and static lighting, with lenses. An examination by a gynecologist in a modern clinic using a colposcope is the norm in Europe!

The device is installed on a special tripod in front of the woman’s vaginal opening. Next, the gynecologist, using a built-in microscope, examines the vaginal tissues under very high magnification, which makes it possible to note even the smallest changes in them. Lighting also helps the gynecologist. The gynecologist, by changing the angle of the light source, can examine scars or folds on the vaginal lining from all angles.

Typically, colcoscopy is performed with a detailed examination of the cervix and vulva. To better examine the surfaces, the gynecologist first removes the discharge using a tampon. Then, to prevent subsequent discharge, the surface of the cervix is ​​lubricated with a 3% solution of acetic acid. If such preparation is not carried out, then, unfortunately, it will not be possible to obtain accurate results. There is no need to be afraid of this moment - the most a woman feels during a gynecological examination is a slight burning sensation in the vagina.

What will an examination with a gynecologist with a colposcope show?

As mentioned earlier, a colposcope allows the doctor to examine even the smallest changes in the structure and color of the epithelial cells of the vagina, which means it is able to detect any ailments at an early stage of development.

• One of the most common diseases detected by a gynecologist with a colposcope is cervical erosion. Characteristic symptoms of erosion are uneven coloring, disruption of the epithelial layer, bleeding, etc.
• Another disease that can be detected with a colposcope is ectopia. With ectopia, the doctor observes significant changes in the shape and color of the epithelium. This is a precancerous condition.
• A pathology that is easily detected during examination with a colposcope is polyps. These are outgrowths of different sizes and shapes. Polyps are dangerous and can quickly increase in size, so they are removed.
• No less dangerous are papillomas that populate the walls of the vagina. These formations can develop into cancer. Papillomas easily reveal themselves when a 3% acetic acid solution is applied to them - they turn pale.
• During colposcopy, the doctor may see thickening of the inner lining of the vagina, which indicates the presence of leukoplakia. If treatment for this pathology is not started in time, tumors may form on the cervix.

The most dangerous disease detected by colposcopic examination during examination by a gynecologist is cervical cancer. If this disease is detected, a biopsy is performed immediately without fail.

Complications, consequences after a gynecological examination with colposcopy

Colposcopy usually does not cause any complications. The normal condition of a woman after a colposcopy procedure is light bleeding.

In rare cases, one of the bleeding options may occur. In this case, you need to urgently contact a gynecologist. Another unpleasant symptom of incipient inflammation is severe cutting pain in the lower abdomen.

Examination by a gynecologist with biopsy

The most important test prescribed for girls and women in gynecology is a biopsy. A biopsy is not considered a mandatory test during a gynecological examination, and is carried out on an individual doctor’s prescription. Its task is to confirm or refute the diagnosis of cancer. If the gynecologist recommends a biopsy, there is no need to panic - often the examination shows that the tumor is associated with inflammation or other processes.

Preparing and performing a biopsy

Diagnostics does not require additional preparation and involves taking biomaterials from the woman’s internal genital organs. A gynecological examination with biopsy is painless and lasts no more than 20 minutes. The tissues are examined under a microscope in the laboratory. The gynecologist will be able to announce the results of the study only after 2 weeks.

In total, there are about 13 different types of biopsies, only 4 of them are used in gynecology. These techniques are the most effective and informative when examining the female reproductive system:

• Incision type - made by scalpel incision of internal tissues;
• Targeted type - carried out by colposcopy or hysteroscopy;
• Aspiration type - extraction of the material necessary for research by aspiration - vacuum suction;
• Laparoscopic type - taking material for research using special equipment. This analysis is taken from the ovaries.

Before the biopsy, you will need to donate blood and urine to exclude complications after the procedure.

Contraindications and complications after a gynecological examination with biopsy

A biopsy performed by a good gynecologist under sterile conditions is safe. But it also has contraindications. A biopsy cannot be done if it is diagnosed:

• blood clotting disorder;
• internal bleeding;
• allergies to the drugs used - anesthesia, aseptic treatment, etc.

After a biopsy, a woman may feel tolerable pain in the vaginal area or lower abdomen. However, the nature of the pain should be strictly pulling. In case of cutting pain, usually accompanied by bleeding, the patient should immediately contact a gynecologist for a re-examination.

You will need to refrain from strenuous physical activity and intimate contact for several days. If no abnormalities are observed in a woman’s body after this procedure, this does not mean that you can violate the gynecologist’s instructions and not come for a re-examination by the gynecologist.

As you can see, an examination by a gynecologist, even in its minimal form, provides extensive information about women’s health!

2. 1. Algorithm for examining the external genitalia.

Indications:

· Assessment of physical development.

Equipment:

· Gynecological chair.

· Individual diaper.

· Sterile gloves.

1. Explain to the woman the need for this study.

2. Ask the woman to undress.

3. Clean the gynecological chair with a rag moistened with a 0.5% calcium hypochlorite solution and lay down a clean diaper.

4. Place the woman on the gynecological chair.

5. Perform hand hygiene:

6. Apply 3-5 ml of antiseptic to your hands (70% alcohol or thoroughly wash your hands with soap).

Wash your hands using the following technique:

Vigorous friction of palms – 10 seconds, repeat mechanically 5 times;

The right palm washes (disinfects) the back of the left hand with rubbing movements, then the left palm washes the right hand in the same way, repeat 5 times;

The left palm is located on the right hand; fingers intertwined, repeat 5 times;

Alternately rubbing the thumbs of one hand with the palms of the other (palms clenched), repeat 5 times;

Alternating friction of the palm of one hand with the closed fingers of the other hand, repeat 5 times;

7. Rinse your hands under running water, holding them so that your wrists and hands are below elbow level.

8. Close the tap (using a paper napkin).

9. Dry your hands with a paper towel.

If it is not possible to hygienically wash your hands with water, you can treat them with 3-5 ml of antiseptic (based on 70% alcohol), apply it to your hands and rub until dry (do not wipe your hands). It is important to observe the exposure time - hands must be wet from the antiseptic for at least 15 seconds.

10. Put on clean, sterile gloves:

· Remove rings and jewelry;

· Wash your hands in the necessary way (regular or hygienic

hand treatment);

· Open the top package of disposable gloves and remove the gloves in the inner package with tweezers;

· Use sterile tweezers to unscrew the upper edges of the standard package, in it the gloves lie with the palm surface up, and the edges of the gloves are turned outward in the form of cuffs;

· With the thumb and index finger of your right hand, grab the inside edge of the left glove from the inside and carefully put it on your left hand;

· Place the fingers of the left hand (wearing a glove) under the lapel of the back surface of the right glove and put it on the right hand;

· Without changing the position of the fingers, unscrew the curved edge of the glove;

· Also unscrew the edge of the left glove;

· Keep your hands in sterile gloves bent at the elbow joints and raised forward at a level above the waist; Examine the external genitalia: pubis, type of hair growth, whether the labia majora and minora cover the genital opening.

11. With the first and second fingers of the left hand, spread the labia majora and sequentially inspect: the clitoris, urethra, vestibule of the vagina, ducts of the Bartholinian and paraurethral glands, posterior commissure and perineum.

12. With the first and second fingers of your right hand, in the lower third of the labia majora, first on the right, then on the left, palpate the Bartholin’s glands.

13. The inspection is completed. Ask the woman to get up and get dressed.

14. Removing gloves:

With the fingers of your gloved left hand, grasp the surface of the edge of the right glove and remove it with an energetic movement, turning it inside out;

Place the thumb of the right hand (without a glove) inside the left glove and, grasping the inner surface, vigorously remove the glove from the left hand, turning it inside out;

Place used gloves in a safe disposal box (safe disposal box)

15. Wash your hands with soap and water

16. Record the inspection results in the primary documentation.

BIMANUAL EXAMINATION TECHNIQUE

General information: bimanual examination is the main method for recognizing diseases of the uterus, appendages, pelvic peritoneum and tissue, and determining the duration of pregnancy.

Indications:

1) preventive examination;

2) examination of gynecological patients and pregnant women.

Workplace equipment:

1) gynecological chair;

2) gloves;

3) containers with disinfectant;

4) individual card of the pregnant and postpartum mother;

5) medical record of an outpatient;

6) antiseptic;

7) rags.

Inform the pregnant or gynecological patient about the need and essence of the manipulation.

Invite the patient to empty her bladder.

Cover the chair with an individual diaper or disposable napkin.

Place on a gynecological chair in a supine position, legs bent at the hip and knee joints and apart.

Toilet the external genitalia according to indications.

Wash your hands and put on sterile gloves.

The main stage of the manipulation.

With your left hand, spread the labia majora and minora.

Insert the second and third fingers of the right hand into the vagina along the back wall.

Determine the condition of the vagina: volume, folding, distensibility, presence of pathological processes, tumor, scars, narrowing, condition of the vaginal vaults.

10. Find out the condition of the cervix, determine its shape, consistency, mobility, sensitivity when displaced.

11.To determine the condition of the uterus, place your left hand on the lower abdomen, your right hand on the anterior fornix, and you can determine the position, shape of the uterus, size, consistency, mobility and pain.

12.To determine the condition of the uterine appendages, the fingers of the outer and inner hands are moved from the corners of the uterus to the lateral surfaces of the pelvis (the ovaries and fallopian tubes are examined, size, shape, soreness, mobility). Normally, the appendages are not palpable.

13. Using the inner hand, palpate the inner surface of the pelvis (ischial spines, sacral cavity, presence of exastoses).

14.Removing your right hand from the vagina, carefully examine it for the presence of discharge and its nature.

The final stage of the manipulation:

15.Remove gloves, wash hands, place gloves in a container with disinfectant.

16. Record the obtained data in the medical documentation.

17. Put on gloves and remove the diaper.

18. Treat the chair with a disinfectant.

3. Examination of the cervix

Equipment. Sterile: Sims spoon-shaped mirror and Ott flat lift or Cusco double-leaf mirror, 2 forceps, rubber gloves, cotton balls, diaper; other: gynecological chair, individual diaper for the patient, antiseptics.

Note. Be sure to warn the patient to empty her bladder, rectum and toilet her external genitalia on the eve of the procedure.

1. Wash and dry your hands. 2. Using sterile tweezers, remove the sterile diaper from the bag, place it on the table next to the gynecological chair and unfold it. 3. Following the rules of asepsis, place on the diaper: vaginal speculum, 2 forceps, rubber gloves, cotton balls. 4. Conduct psychological preparation of the patient. 5. Invite the patient to place an individual diaper on the gynecological chair and undress to the waist from below. 6. Help the patient lie down on the gynecological chair (see practical skills “Toilet of the external genitalia”). 7. Wear sterile rubber gloves. 8. Go to the gynecological chair and stand at the woman’s feet. 9. Treat the external genitalia with an antiseptic solution in accordance with the practical skills “Toilet of the external genitalia”.

Note. The examination is carried out using a Cusco double-leaf mirror or using a Sims spoon-shaped mirror and an Ott flat lift.

Inspection using the Cusco mirror

10. Fold the Cusco mirror in a closed position, holding it in your right hand. 11. Using the thumb and index finger of your left hand, separate the labia in the lower third. 12. Carefully insert the Cusco speculum halfway into the vagina, placing the closed flaps parallel to the genital slit. 13. In the vagina, turn the speculum 90° with the ratchet down and insert it, directing it towards the posterior fornix. 14. Carefully open the mirror, pressing on the parts of the ratchet, to expose the cervix so that it is located between the doors of the mirror. 15. If necessary, secure the mirror using the lock screw. 16. Examine the cervix.

Note. If the cervix is ​​covered with mucus and this interferes with its examination, remove the mucus with a cotton ball on a forceps.

17. Use the screw to loosen the lock so that the speculum flaps move freely and do not compress the cervix. 18. Examine the walls of the vagina, removing the speculum, having previously squeezed it to a semi-closed state.

Inspection using Sims mirror and Ott lift

19. With your right hand, take the Sims spoon-shaped mirror. 20. Using the thumb and index finger of your left hand, separate the labia in the lower third. 21. Insert the speculum halfway into the vagina, placing it obliquely to the genital slit. 22. Turn the speculum into the vagina with the handle down and push it through. 23. Using a speculum, gently press on the back wall of the vagina, expanding the entrance. 24. Parallel to the rear speculum, insert the front speculum - Ott lift and use it to lift the anterior wall of the vagina. 25. Extend the cervix so that it is located between the speculum. 26. Examine the cervix. 27. Examine the vagina, removing the speculum in the reverse order: first remove the lift, examining the anterior wall of the vagina. 28. Then remove the rear speculum, examining the back and side walls of the vagina. 29. Remove rubber gloves and place them in a container for waste material. 29. Remove the rubber gloves and place them in the material container. 30. Help the woman get out of her chair and offer to get dressed. 31. Disinfect used equipment. 32. Wash and dry your hands. 33. Make a note in the appropriate medical document.

General information: colposcopy - examination of the vaginal part of the cervix, the borders of the stratified squamous and columnar epithelium of the surface of the endocervix, vagina and external genitalia with an optical device (colposcope) with an illuminator at a magnification of 4-30 times. There are simple and extended and simple colposcopy. Using simple colposcopy, the shape and size of the cervix, external pharynx, color and relief of the mucous membrane, the transition zone of flat and columnar epithelium, and vascular pattern are determined. Extended colposcopy is based on the use of pharmacological agents (3% acetic acid solution, Lugol's solution) to detect structural changes in tissue at the level of the cell and its components. It allows you to examine a specific area with sufficient optical magnification, as well as perform a targeted biopsy.

Indications:

1) diagnosis of diseases of the cervix and vagina; 2) examination of a gynecological patient before abdominal gynecological operations.

Contraindications:

1) bleeding;

2) menstruation.

Workplace equipment:

1) colposcope;

2) 3% acetic acid solution;

3) cotton balls, tweezers;

4) Lugol's solution;

5) ethyl alcohol 70º;

6) vaginal speculum;

7) sterile gloves;

gynecological chair;

9) individual diaper.

Execution sequence:

Preparatory stage of performing the manipulation.

The patient is placed on a gynecological chair covered with an individual diaper, and the external genitalia are toileted.

The midwife prepares the necessary instruments, materials, and solutions.

He washes his hands, dries them, and puts on sterile gloves.

The main stage of the manipulation.

Midwife assisting doctor

The final stage of the manipulation.

Place used tools and gloves in different containers with disinfectant.

A special gynecological examination begins with an examination of the external genitalia. At the same time, attention is paid to hair growth in the pubic area and labia majora, possible pathological changes (swelling, tumors, atrophy, pigmentation, etc.), the height and shape of the perineum (high, low, trough-shaped), its ruptures and their degree, the condition of the genital area. fissures (closed or gaping), prolapse of the vaginal walls (independent and with straining). When spreading the genital fissure, it is necessary to pay attention to the color of the mucous membrane of the vulva, examine the condition of the external opening of the urethra, paraurethral passages, excretory ducts of the large glands of the vestibule of the vagina, and pay attention to the nature of the vaginal discharge. After examining the external genitalia, you should examine the anal area (the presence of fissures, hemorrhoids, etc.).

The appearance and condition of the external genitalia, as a rule, correspond to age. In women who have given birth, pay attention to the condition of the perineum and genital opening. With normal anatomical relationships of the tissues of the perineum, the genital gap is closed and opens slightly only with sudden straining. When the integrity of the pelvic floor muscles is damaged, the genital fissure gapes even with slight tension, and the walls of the vagina descend.

The mucous membrane of the vaginal opening of a healthy woman is pink. In inflammatory diseases, it can be hyperemic, sometimes with the presence of purulent plaque. During pregnancy, due to congestive plethora, the mucous membrane acquires a bluish color, the intensity of which increases with increasing gestational age.

Hypoplasia of the labia minora and labia majora, pallor and dryness of the mucous membrane and vagina are signs of hypoestrogenism. Juiciness, cyanosis of the vulva, abundant secretion of cervical mucus are signs of increased estrogen levels. Intrauterine hyperandrogenism is indicated by hypoplasia of the labia minora, enlargement of the clitoral head, increased distance between the base of the clitoris and the external opening of the urethra (more than 2 cm) in combination with hypertrichosis. Then they begin research using mirrors, which is especially important in gynecology for identifying pathological changes in the vagina and cervix. Examination using vaginal speculum is a mandatory part of every gynecological examination, since many pathological conditions on the cervix and vagina are not accompanied by specific symptoms. It allows you to assess the condition of the vaginal mucosa (color, folding, tumor formations), its depth. On the cervix, the shape of the external uterine os, the presence of inflammatory changes, tumor formations (polyps, exophytic form of cancer, etc.), and the nature of discharge from the cervical canal are determined.