General Gynecological Examination

A woman medical examination may be needed to clarify a specific problem such as abdominal pain, vaginal bleeding or vaginal discharge. Needed are routine gynecological examinations that can be performed by a gynecologist or general practitioner. They are recommended for all women who are sexually active or over 18 years old at yearly intervals. Obstetric examinations are carried out on issues that are related to pregnancy.

In most women, especially those who visit the doctor for general care, a complete medical history and a general physical examination, in addition to gynecological examination required. A woman medical examination may be needed to clarify a specific problem such as abdominal pain, vaginal bleeding or vaginal discharge. Needed are routine gynecological examinations that can be performed by a gynecologist or general practitioner. They are recommended for all women who are sexually active or over 18 years old at yearly intervals. Obstetric examinations are carried out on issues that are related to pregnancy. Many women look for when gynecologists both general medical and gynecological care. The general medical services may include advice on the overall health and routine checkups for: Hypertension Dyslipidemia Diabetes Depression tobacco use alcohol consumption drug intake more information, see Well-Woman Task Force: Components of the Well-Woman Visit. The history of gynecological history includes the description of the event for the current medical visit (main symptoms, development of the current disease), the bleeding history, obstetric history and sexual history and previous gynecological symptoms, diseases and treatments. The symptoms are first through open questions and then clarified by specific questions: pelvic pain (location, duration, character, quality, triggering and relieving factors) Abnormal vaginal bleeding (amount, duration, depending on the menstrual cycle) discharge (color, smell, texture ) and / or irritation patients of childbearing age, one wonders for signs of pregnancy (z. B. morning sickness, breast tenderness, to the absence of menstruation). The bleeding history includes: age at menarche bleeding time duration and regularity of cycles date of onset of the last menstrual period (LR) data of previous menstrual bleeding (VR) blood color and quantity of accompanying symptoms of menstruation (. Eg cramping, loose stools) is most cases the menstrual medium- to dark red, bleeding time is 5 (± 2) days and the distances between the bleeding 21-35 days; the mean blood loss of 30 mL (13-80 mL), and the strongest circulation takes place on the second day. A napkin or a tampon can accommodate 5-15 ml liquid. Cramps often occur on the day before and on the first Blutungstag on. Vaginal bleeding, stained painless, scanty and dark, unusually short or extended or appear at irregular intervals, can a reference to the lack of ovulation be (anovulation). The obstetrical history includes the data and outputs of all pregnancies, as well as of previous ectopic pregnancies or hydatidiform moles. The sexual history should be done in a professional and unbiased manner include the following: frequency of sexual activity number and sex of the partner application of preventive measures practicing unprotected intercourse impact sexual activity (. Eg satisfaction, orgasm, dyspareunia) contains the gynecological history questions about past gynecological symptoms (eg. as pain), symptoms (eg. as vaginal bleeding, discharge) and known diagnoses and test results. On suspicion of domestic violence should be specifically asked and investigated. Here, questionnaires and targeted interviews with an assistant from the medical staff or the doctor can be used. In patients who do not admit to having experienced violence, the following findings indicate a misuse: Indeterminate explanations for injuries Delayed prospect of the doctor in bruising unusually somatic complaints Psychiatric symptoms Frequent locating the emergency departments injuries to the head and neck Premature birth of a child with low birthweight Physical examination the doctor should tell the patient the study that includes a breast examination and examination of the abdomen and the lower abdomen. For the pelvic exam, the patient lies on his back on the examination chair with your feet in stirrups; usually it is covered. Especially in male investigators an attendant should be present in the rule, which can also assist. The eye exam includes: External audit speculum Bimanual palpation Rectal examination (sometimes) A ??pelvic examination is indicated for symptomatic patients (eg, those with pelvic pain.) Asymptomatic patients with specific indications (eg need for cervical cancer screening.) Some experts recommend that a pelvic exam is used in patients <21 years only performed when it is medically indicated and that ? 21 years takes place every year a pelvic examination in patients. However, there is no evidence to support a pelvic examination for asymptomatic, low-risk patients or disprove. It should for such patients, the decision about how often these tests should be performed then be like when doctor and patient have discussed the issues. External audit pubic hair and, if necessary, inspected for lesions, folliculitis or parasites. The dam is examined if necessary (eg. As ulcers, pustules, nodules, warts, tumors) for redness, abrasions, abnormal pigmentation and lesions. Structural abnormalities due to congenital malformations or mutilation on female genitals are noted. A vaginal opening <3 cm may indicate an infibulation, a severe form of genital mutilation. Next, the Introit between thumb and forefinger is palpated on cysts or Bartholin's abscesses. While the labia are expanded, and the patient is asked to press down, the examiner is looking for signs of vaginal reduction, wherein a protrusion of the front vaginal wall to a cystocele, one of the rear partition to a rectocele and a descent of the cervix in the direction introitus on a uterine prolapse hindeuten.Spekulumuntersuchung Before the speculum is asked the patient, legs and hips to relax and breathe deeply. The speculum sometimes kept warm with a heating pad and can be moistened or lubricated prior to insertion, in particular when the sheath is dry. When a cytological smear Papanicolaou (Pap) test or Zervixkultur is planned, the speculum is rinsed with warm water; the use of lubricants was originally avoided, but the current water-based lubricant can make the exam for the patient more comfortable. A flask equipped with a glove finger is inserted into the vagina to determine the position of the cervix. Upon insertion of the speculum holding the sheets almost perpendicular (about 1 pm and 7 am), at the same time pressing with two fingers on the rear wall of the vagina ( "perineal body") to enhance the vaginal opening. The speculum is inserted toward the cervix, then rotated until the handle facing down, carefully opened and withdrawn until the cervix is ??easily visible. If the cervix to detect the blades are positioned so that the posterior sheet, the cervix is ??lower than (in the posterior fornix) and the anterior sheet may be lifted carefully and anterior cervical (in the anterior fornix) remain. The examiner should make sure to open the anterior sheet slowly and carefully and not to pinch the labia or the dam during the opening of the speculum. Normally, the cervix is ??pink, shiny and without discharge. Cells for the Pap test are removed with a brush or a plastic spatula from the cervical canal and the ectocervix or with a "Cervical sampler" which can receive cells from the cervical canal and the transition region at the same time. Samples are then rinsed in liquid to prepare a cell suspension (HPV) is investigated for cancer cells, and human papilloma virus. Samples to test for sexually transmitted diseases (sexually transmitted diseases [STD]) takes you to the cervical canal. The speculum is gently pulled out the labia with the Spekulumblättern not kneifen.Bimanuelle palpation Before the ambidextrous investigation is asked to the patient, legs and hips to relax and breathe deeply. In the bimanual palpation index and middle fingers of the dominant hand into the vagina to (in Germany not part of a gynecological examination) are just introduced below the cervix. The other hand is gently pushed from the outside just above the symphysis pubis in order to, if possible, to determine size, position and consistency of the uterus and the ovaries. Normally, the uterus is about 6 × 4 cm in size and inclined toward the abdominal wall (anteverted), but it may (retroverted) to varying degrees, rearwardly bent to be. Likewise, the uterus may be bent (or anteflexion retroflexion) forward or backward. The uterus is mobile and smooth; Irregularity arouses the suspicion of uterine fibroids (leiomyomas). Normally, the ovaries in young women about 2 × 3 cm in size and are not palpable in postmenopausal women. On palpation of the ovaries mild nausea and tenderness are normal. A significant pain that is triggered when the gentle lateral movement of the cervix (animation and slide pain) can, to a pelvic inflammatory disease (pelvic inflammatory disease [PID]) schließen.Rektale investigation after bimanual palpation is the rectovaginal septum investigated by the index finger inserted into the vagina and the middle finger into the rectum werden.Kinder the examination process should be adapted to the psychosexual development of the child; mostly he limited to the inspection of the external genitalia. Young children can be examined on the lap of the mother. Older children can be examined tightened with a knee to the breast in the knee-chest position or lying sideways. Vaginal discharge can be removed, examined, and a culture be taken. Sometimes it is useful, with the aid of a small catheter is placed a filled saline syringe to remove rinsing liquid from the vagina. Does the cervix are displayed, a fiber optic vaginoscope, a cystoscope or a flexible hysteroscope with Kochsalzlavage should apply. For children resistances pelvic can by scanning the abdomen werden.Jugendliche found for teens who are not sexually active, the study is similar to that in children. Some experts recommend that pelvic examinations avoided in patients <21 years of age only be carried out if this is medically indicated (eg. as when a patient has a persistent, symptomatic vaginal discharge). All sexually active girls and those who are no longer active, but have a history of a sexually transmitted disease should be offered a pelvic exam. However, doctors can often take a urine sample or vaginal swab to test for sexually transmitted diseases and thus avoid a speculum. Sexually active girls should also be examined annually for chlamydia and gonorrhea. Puberty status is judged. During the visit, information about contraception should, where appropriate given and recommendations for the Human papillomaviruses vaccination (HPV) are discussed. Physicians should take time to talk with girls about personal matters (eg. As contraception, safe sex, menstrual cramps) laboratory testing laboratory investigations are initiated on the basis of symptoms. Pregnancy tests For most women of childbearing age who have gynecological symptoms, conducted pregnancy tests. The determination of the beta subunit of human chorionic gonadotropin (beta-hCG) in urine is specific and very sensitive and is positive in about a week after fertilization. Serum tests are specific and yet sensitiver.Screening tests for cervical cancer to the cervical cancer screening include Pap test Human papillomavirus (HPV) test Zervixzellproben that one takes for the Pap test are examined for signs of cervical cancer. The same sample may also be examined for HPV. Screening tests are routinely performed during most of a woman's life (see also Cervical Cancer Screening Guidelines for Average-Risk Women). In most women, the frequency of screening earlier tests focused primarily on the age of the woman and the results: From the age of 21 to 30: As a rule, every 3 years for the Pap test (HPV test is generally not recommended) Age 30 to 65: every 3 years if only one Pap test is performed, or every 5 years if a Pap test and an HPV test can be performed (more common in women at high risk for cervical cancer) After 65 No further testing if the test results in the previous 10 years have been unremarkable Pap tests should be resumed if a woman has a new sexual partner; they should be continued if it has multiple sexual partners. For women with specific indications (eg. As women with HIV infection), more frequent screening may be required, and the screening can be started at a younger age werden.Mikroskopische examination of the vaginal secretion This study helps in the diagnosis of vaginal infections (eg. B. trichomoniasis, bacterial vaginosis, Pilzinfektionen.Mikrobiologische tests means culture or molecular methods (eg., PCR), the samples of patients with symptoms or risk factors for certain STD-organisms (z. B. Neisseria gonorrhoeae, Chlamydia trachomatis) are investigated. samples can also be taken from urogenital sites, including endocervix (refer during the Pap test) and urine. (See also the US Preventive Services task Force practice guideline screening for gonorrhea and the US Preventive Services task Force practice guideline screening for chlamydial infection.) Zervixschleimuntersuchung The immediate investigation of cervical n mucus sample through a correspondingly formed examiner on the spot can provide insights into the menstrual cycle and hormonal status. This information can be valuable in the diagnosis of infertility, and in the determination of ovulation. The mucus sample is smeared on a slide, dried in the air and on the extent of the formation of microscopic crystals inspected (Farnkrautphänomen) that reflect the estrogen concentrations in the blood. Due to the high levels of estrogen just prior to ovulation, the cervical mucus is clear and abundant, and the Farnkrautphänomen is pronounced. Right after ovulation, the cervical mucus becomes thick and the Farnkrautphänomen is hard to sehen.Bildgebende methods are to use both transvaginal and transabdominal transducers. The imaging of suspicious lesions and other resistance usually happens first means of ultrasound, which can be carried out in practice. Magnetic resonance imaging (MRI) is highly specific, but expensive. Computed tomography (CT) is less suitable due to the lower accuracy, significant radiation exposure, and sometimes due to the need for a contrast agent. Ecografia transvaginal var model = {thumbnailUrl: '/-/media/manual/professional/images/vaginal_ultrasound_high_blausen_de.jpg?la=de&thn=0&mw=350' imageUrl: '/-/media/manual/professional/images/vaginal_ultrasound_high_blausen_de.jpg ? lang = en & thn = 0 ', title:' ecografia transvaginal 'description:' 'credits'', hideCredits: false, hideTitle: false, hideFigure: false, hideDescription: true}; var panel = $ (MManual.utils.getCurrentScript ()) Closest ( 'image-element-panel.'). ko.applyBindings (model, panel.get (0)); Laparoscopy Using this surgical procedure can be seen not only structural abnormalities that are too small to be detected by imaging methods, but also abnormalities on the surface of internal organs (eg. As endometriosis, inflammation, scars). Tissue samples can also be doing gewinnen.Douglas puncture as culdocentesis referred to the needle puncture of the located behind the uterus Douglas space (vaginal back cover fold) with the aim of fluid for bacterial culture or blood from a ruptured ectopic pregnancy or ovarian cyst win .Endometriumaspiration This procedure is performed in women> 35 years with unexplained vaginal bleeding. A thin, flexible plastic Suction curette through the cervix (often there is no need to dilate) up to the internal os introduced. A vacuum is set, the device rotated through 360 ° and a few times up and down to win endometrium from different parts of the uterine cavity. infertility sometimes the uterus by a bullet mold ruhighalten.Andere tests If you need to be clarified or suspected anomalies consists, hormones from the pituitary gland or hypothalamus and ovarian hormones can be examined. Other tests may be performed for certain clinical indications. They include the following tests: colposcopy: examination of the vagina and cervix (by Motion for example, to identify to be biopsied areas endocervical curettage.:. Inserting a curettage to obtain tissue from deep inside of the cervical canal (for example in the kolposkopiegeführten biopsy in order to diagnose cervical cancer) dilation and curettage (D & C): spreading the vaginal walls with a speculum and inserting a curette to tissue from the endometrium or uterine contents incomplete by scraping or scooping to remove (for example, for the treatment of. to remove fluoroscopically imaging of the uterus and tubes with fluoroscopy after instillation of a contrast medium into the uterine cavity (e.g., to lesions of the pelvis and of the uterus, affect the fertilization or implantation or Dysmeno: abortions) hysterosalpingography. might cause rrhö) hysteroscopy: inserting a thin viewing tube (hysteroscope) through the vagina and the cervix (in the uterus used to see the inside of the uterus and to identify abnormalities and / or some surgical procedures using instruments passing through the be introduced laparoscope to perform) loop Electrosurgical excision Procedure (LEEP): use of a thin wire loop, which conducts an electric current used to remove a piece of tissue (eg. As for a biopsy or treatment) Sonohysterographie (ultrasound with saline infusion): injection of isotonic fluid through the cervix into the uterus during ultrasound (for example, for the detection and measurement of small endometrial polyps, other uterine abnormalities and tubal lesions) More information Well-Woman task Force: Components of the Well-Woman Visit Cervical Cancer screening Guidelines for Average-Risk Women Untersuchng on gonorrhea and chlamydia infection

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