Generality
The gynecological examination is a specialized examination that allows the evaluation of the health status of the female genital apparatus .
This appointment is extremely important for every woman, since puberty, as well as an approach to the prevention of female tumors and other reproductive organs pathologies.
The gynecological examination is usually preceded by an informative interview, during which the doctor collects the medical history and explains the stages of the examination step by step. After this first phase, the patient is invited to remove the underwear and sits on the gynecological table, where the doctor proceeds with the external inspection of the genitals, followed by internal control (examination with speculum, vaginal exploration and bimanual palpation ).
What's this
What is the gynecological examination?
The gynecological examination consists in the evaluation of the female genital organs (vagina, uterus, ovaries and fallopian tubes) and of the breast . This exam is performed by the gynecologist to ascertain the correct functioning of the reproductive system and to diagnose the pathologies and dysfunctions that can affect it.
Who is the gynecologist?
The gynecologist is the doctor to turn to for every problem concerning the genital system (diagnosis and treatment), as well as being the reference figure for various aspects of women 's health (pregnancy, contraceptive methods, sexual life, irregular menstrual cycle, vaginal infections, etc.).
What is the purpose of the gynecological examination?
The gynecological examination is an exam that allows:
- Evaluate the health status of the female genital system;
- Diagnose or exclude the presence of pathologies;
- Address a treatment plan.
The gynecological examination is also important for the promotion and prevention of reproductive health of women and couples.
The gynecologist is, in fact, the reference figure for:
- Ask the questions and ask for the explanations you need about intimacy;
- Provide information on correct lifestyles and risk behaviors (eg contraception, hygiene habits, diet, etc.);
- Follow the woman during the period of pregnancy;
- Help women with difficulty conceiving or suspected infertility.
In addition to the gynecological examination, the specialist in obstetrics and gynecology deals with:
- Screening for cervical cancer prevention (Pap test and HPV test);
- In -depth diagnostic investigations (eg colposcopy);
- Execution of various types of surgical procedures (eg removal of fibroids and myomas, closure of the tubes etc.);
- Prescription of drug therapies .
Why do you run
The gynecological examination is an examination that allows to evaluate the normal state of the female genital apparatus and to exclude the presence of pathologies, such as uterine cancer, fibroids or endometriosis, improving the possibility of treatment.
When should I go to the gynecologist?
The gynecological examination can be performed at the request of the woman or the attending physician in the event of:
- Periodic check, useful for the prevention and early diagnosis of diseases of the female genital tract;
- Concerns or need for information on one's health, contraception or sexuality;
- Suspicion of disorders or pathologies of the female genital tract;
- Monitor pregnancy (clinical evaluation, prescription blood chemistry, ultrasound, etc.).
The gynecological examination is strongly recommended if unusual disorders such as:
- Vaginal pain ;
- Intimate burning or itching ;
- Vaginal discharge different from the usual in color, consistency, quantity and / or smell;
- Disorders of the menstrual cycle (irregularity, painful and / or hemorrhagic menstruation, amenorrhea, etc.);
- Pelvic pain of any kind (during menstruation or other days);
- Breast or nipple changes (tenderness, palpable nodules, cysts, mastopathy and secretions);
- Blood leaks between cycles ;
- Pain during sexual intercourse (dyspareunia);
- Problems related to menopause and senility .
The gynecological examination can also be performed for the monitoring of previously diagnosed diseases (eg vaginitis, ovarian cysts, endometriosis, etc.) and for prescribing birth control therapy . Furthermore, it is recommended to consult the gynecologist in case of occasional unprotected sexual intercourse, for fear of an unwanted pregnancy or having contracted a venereal disease.
How often do you have a gynecological examination?
Regardless of age, it is advisable to undergo an annual or biennial gynecological check-up, even if it looks good. In the presence of particular problems that require more frequent monitoring, the doctor may indicate a different periodicity.
At what age do the first gynecological examination take place?
The age at which to undergo a gynecological examination for the first time may vary depending on some factors, such as the presence of particular disorders (eg inflammation of the external genitals, alterations in the development of the genital apparatus and hormonal dysfunctions) and the onset of sexual activity .
In general, it is good to undergo a check between 16 and 21 years, to check that there are no problems, or within a year of the first sexual intercourse. Of course, it is possible to go to the gynecologist even earlier, to clarify all the doubts concerning the menstrual cycle.
Regardless of the young age, then, the gynecological examination must be performed in all cases in which abnormal symptoms are found, such as:
- Abundant or smelly vaginal discharge;
- Intimate itching or burning;
- Lower abdominal pains;
- Abdominal swellings;
- Irregular cycle or absent at 15-16 years.
In most cases, the first menstruation (menarche) occurs between the ages of 10 and 16, although the first menstrual flows appear on average at 12-13 years. For girls, the first gynecological examination is useful for an approach to aspects of sexuality that are unclear (note: with the menarche and the first ovulation, the beginning of a pregnancy is possible) and to receive advice on the available contraceptive methods and best suited to your needs.
Gynecological examination: can it be done when you are a virgin?
The gynecological examination can be performed even if there have not yet been cohort relationships; in this case, the doctor will use special instruments, which can also be introduced through an intact hymen, and will be as delicate as possible. For virgin women, if necessary, the gynecological examination could be performed rectally.
Preparation
Gynecological examination: is there a particular preparation?
There is no need for a special preparation to undergo a gynecological examination.
Before the appointment, to feel at ease, one can wash and depilate as usual (in general, the presence of superfluous hair is not a detail that the doctor cares about).
To perform the gynecological examination, it is advisable that the rectum and bladder are empty, unless otherwise indicated by the doctor (for example, due to the need to perform a pelvic ultrasound).
How to dress for the gynecological visit?
In general, to go to the gynecological examination, it is advisable to wear comfortable and practical clothes to put on and take off. In the doctor's office, usually, there is a corner protected by a screen, where the patient can undress and rest clothes.
During the gynecological examination it is not necessary to undress completely: unless otherwise indicated by the gynecologist, it is necessary to at least remove the briefs and unfasten the bra.
Gynecological examination: can it be done with menstruation?
If the gynecological examination is scheduled for a check, it is preferable to fix it in the absence of the flow. The menstrual blood can interfere, in fact, with the execution of the Pap test and can invalidate the results of some laboratory tests. The best time to perform the gynecological check-up is from the 10th to the 18th day from the beginning of the menstrual cycle.
In the event that the appearance of the flow arrives unexpectedly a few days before the gynecological examination, it is advisable to evaluate with your gynecologist if it is appropriate to postpone the appointment to another date. In urgent situations, in the metrorrhagia or in case of threat of abortion, on the other hand, the gynecological examination is also carried out with blood loss.
Pap test preparation
The Pap test (or Papanikolaou test) can be performed as part of a screening program for cervical cancer (every two to three years) or as a routine check during the gynecological examination. This examination highlights early any changes in the cervix (from the presence of tumor or precancerous cells to inflammation), offering the possibility of treating and resolving the lesions in their initial stage, before they degenerate in the neoplastic sense.
If during the routine gynecological examination the Pap test is scheduled, it is important to follow the exam preparation rules, in order not to compromise the outcome.
To learn more: Pap test - What is it and How is it performed? »How it happens
Gynecological examination: which phases do you foresee?
The gynecological examination takes place in the following sequence:
- Informative interview (anamnesis);
- External exam :
- Inspection and palpation of external genitalia;
- Internal examination :
- Examination with the speculum;
- Vaginal exploration and bimanual palpation (or abdomino-pelvic exploration);
- Rectovaginal palpation or rectal exploration (sometimes).
Faced with specific needs or problems, this basic scheme can be modified by the gynecologist, adding a breast examination or supporting instrumental investigations .
For example, the gynecological examination can be completed by a transvaginal ultrasound, to assess the presence or suspicion of diseases such as fibroids, endometrial polyps or ovarian cysts.
Initial interview
Like any other medical check-up, the gynecological examination includes an initial interview, which allows the doctor to collect the information necessary for the necessary investigations ( medical history ), taking into consideration the main reason for the visit ( routine check-up or specific pathology ).
For some girls and women, this interaction also helps to overcome the embarrassment or anxiety associated with this "delicate" moment. During this phase of the gynecological examination it is important to answer with sincerity : the more the answers are precise, the more the gynecologist can be accurate and precise in the diagnosis.
During the gynecological examination, the information collected by the gynecologist includes:
- Date of the last menstruation;
- Age of onset of the first menstruation (menarche);
- Characteristics of the menstrual cycle: rhythm (ie every how many days there are menstruation), loss of blood between one cycle and another, presence or absence of premenstrual syndrome (PMS) etc .;
- Characteristics of menstruation: quantity and duration of losses, presence or absence of dysmenorrhea;
- Daily use of drugs (which and why);
- Most important diseases of family members (family history), such as tumors, diabetes, menstrual irregularities, early menopause, thyroid dysfunction and coagulation disorders.
Regarding the disorders that induce to contact the gynecologist, the patient must report precisely:
- Signs and symptoms (vaginal discharge, itching, intimate burning, pain, etc.);
- Moment and circumstances in which they are manifested;
- Factors that make them worse or contribute to relieve themselves;
- Diagnosis or examinations already carried out by other specialists (in this case, it is useful to bring the documentation with you).
During this first phase of the gynecological examination, the doctor can collect information about possible illnesses in the past, allergies, surgical interventions, pregnancies and lifestyle (contraceptive method used, smoking habits, alcohol or drug intake, sports practice, quality sleep, appetite disturbances and body weight, possible constipation and disorders of urinary function). The interview can end with the detection of blood pressure, weight and height.
External examination
The patient is seated on the gynecological table, which includes two supports to support the legs and keep them raised and spread. The position may seem uncomfortable or embarrassing, but it is the best way to perform the gynecological examination.
The gynecologist begins with the inspection of the pelvic region to observe if there are evident swellings of the abdominal wall or scars from previous surgical operations (eg cesarean section, appendicitis, etc.).
The gynecological examination involves the evaluation of the hairs, the panniculus adiposus and the skin of the pubis, followed by the examination of the inguinal lymph nodes and the external genitalia (hymen, clitoris, large and small lips, urinary meatus, outlet of the vaginal glands, perineum and anus). The latter are observed to verify that there are no signs of infection, malformations, inflammations or other abnormalities, such as swelling, erythema, pigmentation changes, hematomas, ulcerations and nodules. At this stage, signs may be found indicative of genital herpes (small groups of small vesicles), lichen simplex (external evocative traumas, such as scratching for vulvar itching), condylomata acuminata (perianal or vulvar growths) and bartholinitis (inflammation of Bartolini's glands). The alterations of the lymph nodes can be related, instead, to sexually transmitted diseases and neoplasias .
During the external gynecological examination, the doctor asks the patient to cough to verify that there are no prolapses of the uterus and / or vaginal walls, as well as involuntary loss of urine . The examination of the large and small lips allows you to highlight sore spots, redness, swelling or abnormal secretions.
Internal examination
The internal gynecological examination is divided into two parts:
- Examination with the speculum . The speculum consists of two valves that can spread out, made of metal or plastic and available in various sizes. Inserted in the vagina, this tool allows you to clearly see the internal walls, identifying any abnormalities present (such as, for example, inflammation, polyps, suspicious lacerations and secretions). The speculum also allows the neck of the uterus to be visualized (color, erosions, ulcerations and pathological formations) and to possibly perform a Pap test.
- Vaginal exploration and bimanual palpation . Once the speculum has been removed, the gynecological examination includes the evaluation of the uterus and annexes . In practice, the gynecologist inserts two fingers of the right hand - the index and the middle - in the vagina and with the left one presses on the surface of the lower part of the abdomen, at a distance about halfway between the pubic symphysis and the navel, to appreciate the pelvic organs (uterus and ovaries). Pushing the fingers of the right hand upwards and ventrally, the doctor palpates the uterus with his left hand, managing to evaluate its shape, consistency, position and mobility. Moving the hands to the right and left, instead, controls the state of the ovaries (usually, they are the size of a walnut, but are reduced in menopausal women) and of the tubes (normally they are very thin and difficult to palpate; otherwise they are always a pathological finding). The bimanual palpation ends with palpation of the posterior vaginal wall, to assess the tenderness of Douglas cord. At the extraction of the hands, the gynecologist pays attention to secretions or blood traces.
Rectal examination
In some cases, rectal exploration and rectovaginal palpation are performed as a completion to the gynecological examination . These controls allow to appreciate the posterior wall of the uterus and highlight new growths or collections that can be easily examined from the finger introduced into the rectum.
- The rectovaginal palpation during the gynecological examination is useful to diagnose the presence of condyloma, polyps, hemorrhoids and anal fissures. Introducing the index finger in the vagina and the middle finger in the rectum, the septum separating the two anatomical districts is examined simultaneously, evaluating thickening or tenderness.
- Rectal exploration replaces vaginal examination in virgin women or in those situations where the latter is difficult ( vaginismus ) or impossible ( agenesis or vaginal atresia, synechiae, etc.).
Breast examination
The doctor can complete the gynecological examination by performing the examination of the breast, by inspection and palpation, to check that there are no nodules or other abnormalities.
After the evaluation, the doctor teaches the patient how to perform breast self-examination ; this should be done by every woman once a month, preferably a week after the end of menstruation, when the breast is not swollen or sensitive.
To learn more: Breast self-examination - ways and times »How long is the gynecological examination?
The duration of the gynecological examination is variable: normally, it takes 15-20 minutes on average. If supplemented by pelvic or transvaginal ultrasound, the gynecological examination is carried out in about half an hour.
Results
Gynecological examination: how does it end?
At the end of the gynecological examination, the doctor will make a description to the patient of what has been verified. If pathologies of the female reproductive system are found, the gynecologist can deepen the clinical picture by carrying out more targeted investigations (eg colposcopy, cervical swab, endometrial biopsy, etc.), also making use of the collaboration of other specialists.
At the end of the diagnostic procedure, the doctor can establish the most appropriate therapeutic program for the case.
Furthermore, if medications or contraceptives are prescribed, the doctor will provide the patient with how they work, what their properties are, how they are used and the possible side effects.
Exams complementary to the Gynecological examination
During the gynecological examination, depending on the symptoms present and the suspected diagnosis, several tests may be required, including:
- Pregnancy test (human chorionic gonadotropin assay);
- Microscopic examination of vaginal secretions to identify infections (eg trichomoniasis, bacterial vaginitis, candidiasis, etc.);
- Microbiological tests with culture methods or molecular analyzes, such as polymerase chain reaction (PCR), for the detection of microorganisms responsible for sexually transmitted diseases (eg Neisseria gonorrhoeae, Chlamydia trachomatis etc. );
- Examination of cervical mucus for the evaluation of infertility and ovulatory period.
Some advice
Gynecological examination: who to contact? Where is it carried out?
The gynecological examination can be performed by a private or public gynecologist, at a hospital or at a family counseling center (a place of reference for women, couples and families).
In public hospitals or private facilities affiliated with the National Health Service (SSN), you can book directly with the local health authority (ASL or Ausl), without the need of a doctor's appointment.
How to choose the gynecologist?
The choice of the doctor to turn to is important and depends, in part, on personal factors: the exam must not be embarrassing and the patient must feel at ease. In practice, a trusting relationship must be established with the gynecologist, man or woman. If you prefer, before the actual gynecological examination, you can make an appointment to get to know the doctor and ask him some questions about everything that is not clear. In fact, even the security deriving from precise and in-depth explanations helps to guide the choice.
It should also be remembered that the gynecologist, like all doctors, is subject to professional secrecy and is obliged to respect the patient's privacy. Therefore, he is not allowed to give information about the girl / woman without her will.
Gynecological examination: is it painful?
If the vaginal musculature is relaxed, the gynecological examination is not painful. During the exam, it is useful to remember to breathe slowly and deeply, trying not to stiffen the abdominals.
However, for many women, the exam can be embarrassing or a cause for concern.
For this, the doctor should:
- Act with tact, performing maneuvers gently and providing the patient with explanations about what you are about to do;
- Check that the position assumed is comfortable;
- Maintain eye contact with the patient and observe the reactions, speaking and reassuring her if she feels muscle tension.
If the woman is quiet and follows the instructions of the doctor, cooperating in the examination, the gynecological examination is facilitated and is certainly of better quality.
