The basic diagnosis
The physical examination takes place on the notorious gynecological chair. Even though its shape rather deters and he conveys a sense of being at the mercy of many others through his leg support devices, he allows both the examiner and the patient the best possible position in this situation: The abdominal wall is relieved by the slight elevation of the upper body and soft and easy to palpate, the padding of the chair also in the back area counteracts a hollow back and helps the patient to relax as much as possible, and the spreading of the legs gives the doctor the ability to easily see and feel the vaginal region. Immediately before starting the examination, the patient should visit the toilet again - only with a deflated and therefore small bladder, the doctor can assess the region correctly.
Examinations with the speculum
First, the doctor will look for externally visible signs of disease (inspection), for example, redness, small pustules or mucous secretions on the outer genitals. Then the doctor spreads with two fingers carefully the labia and examines the inside of the vagina (vagina).
Then he introduces the speculum (vaginal level). This is a metal examining instrument that spreads the vagina a bit and allows the vagina wall and cervix to be evaluated and - for example, as part of a preventive examination - smears taken for microscopic examination.
Depending on the question, the doctor can use a colposcope in the same examination, a magnifying glass with a light source, which is placed in front of the entrance to the vagina and with which the internal structures can be assessed in 10-40x magnification.
In special examinations such as the acetic acid test, the mucous membrane is wetted with a tincture and then discolored depending on the cell type. In this way, suspicious districts can be displayed very well and tissue samples taken from them. Since the speculum size is indeed selected according to the size of the vagina, these examinations are usually not painful, uncomfortable at best. The prerequisite for this, however, is that the patient succeeds in relaxing her pelvic floor area.
The next step is palpation of the internal genital organs with two hands ("bi-manual"). For this purpose - depending on the size of the vagina - only the index finger or index and middle finger of one hand (with glove and lubricant) is inserted into the vagina, with the other hand presses the doctor from the outside above the pubis against it. So he can grope the vagina, the cervix, the uterus and the fallopian tubes between his hands. This bimanual palpation is perceived by many patients as unpleasant pressure; However, it should not be painful.
As part of the early detection of cancer, the doctor can also connect a rectal palpation, in which localized tumors can be detected by palpation of the rectum. Also, the simultaneous examination of rectum and vagina with one finger, the holding straps of the uterus and the pelvic wall can be well assessed (bidigital rectovaginal examination).
During pregnancy, the doctor can palpate the abdomen from the outside with certain manipulations (Leopold handles) and thus gain various information, for example on the position and size of the child. In addition, he also examines the vagina and - later - from the intestine.
Breast examination (Mammadiagnostik)
Part of the gynecological examination, especially with regard to the early detection of cancer is the distribution of the breasts by inspection (inspection) and palpation. Attention is paid, among other things, to the symmetry of the breasts, the skin, the nipples, secretions, lumps or adhesions, lack of mobility when lifting the arms, pressure pain and lymphadenopathy. Depending on requirements, imaging techniques such as mammography, ultrasound or magnetic resonance imaging can be used.