This appointment is extremely important for every woman, starting from puberty, as well as an approach to the prevention of female cancers and other pathologies of the reproductive organs.
The gynecological examination is usually preceded by an informative interview, during which the doctor collects the anamnestic information and explains step by step the stages of the examination. After this first phase, the patient is asked to remove her underwear and sits on the bed gynecological, where the doctor proceeds with the external inspection of the genitals, followed by the internal control (examination with the speculum, vaginal exploration and bimanual palpation).
(vagina, uterus, ovaries and fallopian tubes) and breasts. This examination 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 any 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, irregularities in the menstrual cycle , vaginal infections etc.).
What is the Gynecological Examination for?
The gynecological examination is an examination that allows you to:
- Evaluate the state of health of the female genital system;
- Diagnose or exclude the presence of pathologies;
- Address a treatment plan.
The gynecological examination is also important from the point of view of promoting and preventing the reproductive health of women and couples.
The gynecologist is, in fact, the reference figure for:
- Ask the questions and ask for the explanations you feel the need regarding intimacy;
- Provide information on correct lifestyles and risk behaviors (eg contraception, hygiene habits, diet, etc.);
- Follow the woman during the period of pregnancy;
- Helping women with difficulty conceiving or suspected infertility.
In addition to the gynecological examination, the specialist doctor in obstetrics and gynecology deals with:
- Screening for the prevention of cervical cancer (Pap test and HPV test);
- In-depth diagnostic investigations (eg colposcopy);
- Performing various types of surgical interventions (eg removal of fibroids and myomas, tubal closure, etc.);
- Prescription of drug therapies.
When should I contact the gynecologist?
The gynecological examination can be performed at the request of the woman or the attending physician in case of:
- Periodic control, useful for the prevention and early diagnosis of pathologies of the female genital system;
- Concerns or need for information about your health, contraception or sexuality
- Suspicion of disorders or pathologies of the female genital system;
- Monitor pregnancy (clinical evaluation, blood chemistry test prescription, ultrasound, etc.).
The gynecological examination is strongly recommended if unusual disorders appear such as:
- Vaginal pain
- Burning or intimate itching;
- Vaginal discharge different from usual in color, consistency, quantity and / or odor;
- Disorders of the menstrual cycle (irregularities, painful and / or bleeding periods, amenorrhea, etc.);
- Pelvic pain of any kind (during menstruation or on other days);
- Breast or nipple changes (tenderness, palpable lumps, cysts, mastopathy and discharge)
- Blood loss between cycles;
- Pain during sexual intercourse (dyspareunia);
- Problems related to menopause and senility.
The gynecological examination can also be carried out for the monitoring of previously diagnosed pathologies (eg vaginitis, ovarian cysts, endometriosis, etc.) and for the prescription of contraceptive therapy. In addition, it is recommended to consult a gynecologist in case of unprotected casual sexual intercourse, for fear of unwanted pregnancy or of having contracted a venereal disease.
How often should a gynecological examination be carried out?
Regardless of age, it is advisable to undergo an annual or biennial gynecological check-up, even if apparently you are well. In the presence of particular problems that require more frequent monitoring, the doctor may indicate a different periodicity.
At what age should the first gynecological examination be done?
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 system and hormonal dysfunctions) and the onset of "sexual activity.
In general, it is good to undergo a check-up between the ages of 16 and 21, to check that there are no problems, or within one year of the first sexual intercourse. Of course, it is possible to go to the gynecologist even earlier, to clarify all 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 foul-smelling vaginal discharge
- Intimate itching or burning
- Pain in the lower abdomen;
- Abdominal swelling;
- Irregular or still absent cycle at 15-16 years.
In most cases, the first menstruation (menarche) occurs between 10 and 16 years, although the first menstrual flows appear on average at 12-13 years. For girls, the first gynecological examination is useful for an approach to the aspects of sexuality that are unclear (note: with menarche and the first ovulation it is possible to start a pregnancy) and to receive advice on the contraceptive methods available 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 you have not yet had coital intercourse; 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. Virgin women could be given rectal gynecological examinations if necessary.
it is not a detail that the doctor cares).To carry out 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 examination?
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, there is usually a corner protected by a screen, where the patient can undress and put down her clothes.
During the gynecological examination it is not necessary to undress completely: unless otherwise indicated by the gynecologist, it is at least necessary to remove the panties and undo the bra.
Gynecological examination: can it be done with menstruation?
If the gynecological examination is scheduled for a check-up, it is preferable to fix it in the absence of flow. 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 unexpectedly arrives a few days before the gynecological examination, it is advisable to evaluate with your gynecologist whether it is advisable to postpone the appointment to a "different date". In urgent situations, in cases of bleeding or in the event of a 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 cervical cancer screening program (every two to three years) or as a routine checkup during a gynecological visit. This examination highlights any changes in the cervix early (from the presence of cancer or precancerous cells to inflammation), offering the possibility of treating and resolving the lesions in their initial stage, before they degenerate in a neoplastic sense.
If the Pap test is to be performed during the routine gynecological examination, it is important to follow the rules for preparing the exam, so as not to compromise the outcome.
For further information: Pap test - What is it and How is it performed?);- Inspection and palpation of the external genitalia;
- Examination with the speculum;
- Vaginal exploration and bimanual palpation (or abdominal-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 exam 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 (anamnesis), 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 respond with sincerity: the more precise the answers, 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 last menstruation;
- Age of onset of the first menstruation (menarche);
- Characteristics of the menstrual cycle: rhythm (ie how many days you have menstruation), blood loss between one cycle and the other, 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);
- Major illnesses of family members (family history), such as cancer, diabetes, menstrual irregularities, premature menopause, thyroid dysfunction and bleeding disorders.
Regarding the disorders that lead to contact the gynecologist, the patient must report precisely:
- Signs and symptoms (vaginal discharge, itching, burning, pain, etc.);
- Time and circumstances in which they are manifested;
- Factors that make them worse or help alleviate them;
- 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 any previous illnesses, allergies, surgeries, pregnancies and lifestyle (contraceptive method used, smoking habit, alcohol or drug intake, sports practice, quality sleep disorders, appetite and body weight disorders, possible constipation and urinary function disorders). The interview may end with the measurement of blood pressure, weight and height.
External examination
The patient is made to sit on the gynecological table, which provides two supports to support the legs and keep them raised and spread apart. The position may seem uncomfortable or embarrassing, but it is the best way to perform the gynecological examination.
The gynecologist begins by inspecting the pelvic region to see if there are any evident swellings of the abdominal wall or scars from previous surgery (eg caesarean section, appendicitis, etc.).
The gynecological examination involves the evaluation of the hair, the adipose panniculus and the skin of the pubis, followed by the examination of the inguinal lymph nodes and external genitalia (hymen, clitoris, large and small labia, urinary meatus, outlet of the vaginal glands, perineum and anus). The latter are observed to verify that there are no signs of infection, malformations, inflammation or other abnormalities, such as swelling, erythema, pigmentation changes, bruises, ulcerations and nodules. indicative of genital herpes (clusters of small vesicles), lichen simplex (evocative external trauma, such as scratching, for a vulvar itch), acute warts (perianal or vulvar growths) and Bartholinitis (inflammation of the Bartholin glands). lymph nodes may be related, however, to sexually transmitted diseases and neoplasms.
During the external gynecological examination, the doctor asks the patient to cough to check that there are no prolapses of the uterus and / or vaginal walls, as well as involuntary loss of urine. The examination of the labia majora and labia allows to highlight points painful, red, swollen or abnormal secretions.
Internal examination
The internal gynecological examination is divided into two moments:
- Examination with the speculum. The speculum consists of two valves that can spread apart, made of metal or plastic and available in various sizes. Inserted into 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 you to view the neck of the uterus (color, erosions, ulcerations and pathological formations) and possibly perform the Pap test.
- Vaginal exploration and bimanual palpation. Once the speculum has been removed, the gynecological examination involves the evaluation of the uterus and appendages. In practice, the gynecologist inserts two fingers of the right hand - the index and middle fingers - into the vagina and with the left one presses on the surface of the lower abdomen, at a distance approximately halfway between the pubic symphysis and the navel. , to appreciate the pelvic organs (uterus and ovaries). By pushing the fingers of the right hand up and ventrally, the doctor palpates the uterus with the left hand, managing to evaluate its shape, consistency, position and mobility. By moving the hands to the right and left, instead, he checks the state ovaries (usually the size of a walnut, but shrinking in menopausal women) and fallopian tubes (they are usually very thin and difficult to palpate; otherwise they are always a pathological finding). palpation of the posterior vaginal wall, to evaluate the tenderness of the Douglas cavity. When the hands are removed, the gynecologist pays attention to secretions or blood traces.
Rectal examination
In some cases, rectal exploration and recto-vaginal palpation are performed as a complement to the gynecological examination. These checks allow to appreciate the posterior wall of the uterus and highlight growths or collections that can be easily examined by the finger introduced into the rectum.
- Rectovaginal palpation during the gynecological examination is useful for diagnosing the presence of warts, polyps, hemorrhoids and anal fissures. By introducing the index finger into the vagina and the middle finger into the rectum, the septum separating the two anatomical districts is simultaneously examined, evaluating thickening or tenderness.
- Rectal examination replaces vaginal examination in virgin women or in those situations where the latter is difficult (vaginismus) or impossible (vaginal agenesis or atresia, synechiae, etc.).
Breast examination
The doctor can conclude the gynecological examination by carrying out the examination of the breast, by inspection and palpation, to verify that there are no lumps or other abnormalities.
After the evaluation, the doctor teaches the patient how to perform a breast self-exam, which should be done by each woman once a month, preferably one week after the end of menstruation, when the breasts are not swollen or tender.
To learn more: Breast Self-examination - Ways and TimesHow long does the gynecological examination last?
The duration of the gynecological examination varies: as a rule, it takes an average of 15-20 minutes. If integrated with pelvic or transvaginal ultrasound, the gynecological examination is carried out in about half an hour.
, endometrial biopsy, etc.), also with the collaboration of other specialists.
At the end of the diagnostic process, the doctor can establish the most suitable therapeutic program for the case.
Furthermore, if drugs or contraceptives are prescribed, the doctor will provide the patient how they work, what their properties are, how they are used and the possible side effects.
Complementary examinations to the Gynecological Examination
During the gynecological examination, based on the symptoms present and the diagnostic suspicion, various 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 the polymerase chain reaction (PCR), to search for microorganisms responsible for sexually transmitted diseases (eg. Neisseria gonorrhoeae, Chlamydia trachomatis etc.);
- Cervical mucus examination for the evaluation of infertility and ovulatory period.
