Gynecological examination refers to the examination of the reproductive system of the woman.
It also provides general medical care and does a more general physical examination during the gynecologic visit.
Gynecological examination is a type of examination that every woman should have at least once a year, regardless of a single or married woman.
Gynecological examinations are necessary not only for the treatment of diseases but also for a healthy life and for the continuation of healthy generations. Every woman who cares about her health should undergo a gynecological examination at least once a year.
For the gynecologic exam, a woman should choose a gynecologist with whom she can comfortably discuss her private and sensitive topics, such as sex, birth control, pregnancy, problems related to menopause, and any other issues.
While some women may be quite open in disclosing their sexual, reproductive, and genital concerns, others will find such discussions embarrassing or socially inappropriate. Thus, it is essential that a gynecologist should maintain a sensitive and nonjudgmental approach during this encounter.
The first gynecologic consultation is recommended between the ages of 13 and 15 at puberty (The American College of Obstetricians and Gynecologists (ACOG)). The extent of the examination in adolescents depends on the individual needs of the patient.
This interview may be limited to age-appropriate education on reproductive health issues. If there are no complaints or specific concerns, no gynecological examination is performed.
A gynecologic evaluation includes the gynecologic history and gynecologic examination. The gynecologic history is obtained in a relaxed and private setting, the patient is interviewed alone before she is asked to disrobe.
Before the examination, the gynecologist will inquire in detail about the age at marriage, duration of the marriage, how many times that have married, certain medications, educational status, work, workplace, past illnesses and surgeries, current diseases, bleeding tendency, and diseases in the family.
• Regarding menstruation: The gynecologist will ask questions about the periods such as when the first menstruation started, how many days the period lasts, prior history of menstrual irregularity, prior history of heavy or intermenstrual bleeding, or spotting, Prior history of pain during menstruation (dysmenorrhea) bleeding during or after sexual intercourse, premenstrual tension, clotted menstruation or color of blood, menstrual irregularity (absence or delay).
Women of reproductive age and in the menopausal transition: Date of last menstrual period (LMP; first day of bleeding or spotting),date of previous menstrual period, current cycle length (interval between LMP and previous menstrual period),and regularity (cycle pattern over the past year),number of days of bleeding in an average menses, current or recent heavy or intermenstrual bleeding, current or recent postcoital bleeding, current or recent dysmenorrhea, presence of premenstrual symptoms.
For postmenopausal women: Age at last menstruation, history of hormone therapy, history of postmenopausal bleeding.
• Regarding pregnancies: History of all pregnancies, history of miscarriages, terminations, or ectopic pregnancies.
For each pregnancy: Time of delivery, gestational week at delivery, mode of delivery, the indication for operative delivery, complications for the mother, such as hypertension or diabetes, complications of the fetus, such as growth restriction, anomalies, or stillbirth, delivery or operative complications, neonatal problems, the current health of children.
• Sexual life: Sexual problems, painful intercourse, bleeding after sexual intercourse.
• Contraception methods: Which method in the past and still, and when?
• Infertility: Infertility is defined as the failure of a couple to conceive after 12 months of regular intercourse without the use of contraception in women less than 35 years of age, and after six months of regular intercourse without the use of contraception in women 35 years and older. Once the diagnosis is established, the infertility history should focus on three factors: ovulation, tubal and uterine problems, and male problems.
• Current or past pelvic, vaginal or vulvar infections – vaginal discharge, lesions in the vulva or vagina, fever, pelvic pain, abnormal bleeding, abnormal genital tract bleeding, prior sexually transmitted diseases or pelvic inflammatory disease (diagnosis, frequency, and treatment),certain habits (such as vaginal douching).
• Smear - Pap test history – when it was done, the results, the treatments done. The diagnosis and follow-up of abnormal Pap smears.
• Previous gynecological problems: Ovarian cysts, fibroids, infertility history, endometriosis, polycystic ovary syndrome - their diagnosis and treatment.
• Pelvic organ prolapse, urinary incontinence, groin and abdominal pain, urinary and defecation difficulties.
• Past gynecological procedures: Endometrial biopsy, laparoscopy, hysteroscopy, etc. date, the reason for doing it, complications.
The gynecologist should be informed about issues such as sexual violence.
Although gynecological examinations and ultrasounds are very short and painless procedures, they arouse excitement and fear in many women. These concerns are especially high in people who will be examined for the first time.
If a woman has prior knowledge about what she will experience during the gynecological examination, this will reduce her worries.
When she has any questions or fears about the gynecologic examination, she should talk with her gynecologist beforehand about her concerns. If in any part of the examination she feels pain, she should let the doctor know.
The gynecologic examination begins with a general physical examination. The gynecologist may check the neck and the thyroid gland to find out if there are lumps and abnormalities. An enlarged, overactive thyroid gland may cause menstrual abnormalities.
The gynecologist also examines the skin for signs of acne, excess body hair that is more typical of men, spots, and growths. The gynecologist may also check the entire abdomen for abnormal growths or enlarged organs, especially the liver and spleen, the groin for enlarged lymph nodes, and hernias.
The gynecological examination is performed on the gynecological table. The woman should empty her bladder before the examination and may be asked to collect a urine sample for analysis.
During the pelvic examination, the woman lies on her back with her hips and knees bent and her buttocks moved to the edge of the examining table, a drape is provided for the legs and buttocks. Before the pelvic examination begins, the woman is asked to relax and breathe deeply.
A pelvic examination is carried out:
• Examination of the external genitalia: The gynecologist spreads the tissues around the opening of the vagina (labia) and examines the opening and inspects the external genital area, notes the distribution of hair and any abnormalities, discoloration, discharge, or inflammation. The examination of the external genital area may maybe in normal appearance or detect some abnormalities and may give clues to hormonal problems, cancer, infections, injury, or sexual abuse.
Bartholin and paraurethral glands — The Bartholin gland openings are located at the 4 and 8 o'clock positions just outside the hymenal ring. The glands are not palpable when healthy.
• Examination of the internal genital organs: For those who are not virgins, an internal pelvic examination is done with a speculum (a plastic instrument that spreads the walls of the vagina apart) appropriate size, lubricated with warm water or a water-soluble lubricant that is inserted into the vagina to examine the deeper areas of the vagina and the cervix. Vaginal lesions, anomalies, or atrophic mucosa are noted. Sometimes the gynecologist will ask the woman to push down (like defecation) to check for bladder, rectum, or bowel prolapse into the vagina (called pelvic organ prolapse) for evaluation of the degree of vaginal wall relaxation and uterine prolapse.
If an abnormal discharge is identified, the volume, color, consistency, and odor are noted and a sample is taken with a cotton swab for vaginal infections and/or sexually transmitted diseases.
The cervix is examined closely for signs of irritation, infection, or cervical cancer. A sample using a small plastic brush is taken for the Pap smear test to screen for cervical cancer.
• Manual examination: After removing the speculum from the vagina, the gynecologist inserts the index and middle fingers of the gloved dominant hand into the vagina and checks the strength and support of the vaginal wall, growths, or tender areas within the vagina and the cervix. With the fingers still in the vagina, the gynecologist then places the fingers of the other hand on the lower abdomen above the pubic bone to sweep the pelvic organs downward, while the vaginal hand is simultaneously elevating them, called a bimanual examination. The bimanual examination gives information about the consistency, position, size, mobility, position, sensitivity, and degree of tenderness (if any) of the pelvic organs.
By bimanual examination, the gynecologist moves the hand on the abdomen more to the side and exerts slightly more pressure to check how large the ovaries are and whether they are tender. This part of the examination might be slightly uncomfortable, but it should not be painful.
• Ultrasound: A vaginal ultrasound is then performed by a vaginal ultrasound probe. In this way, the uterus and ovaries are visualized. In those who are virgins, a pelvic ultrasound is done by abdominal route, with a full bladder, or ultrasound by the vaginal probe transrectally.
• Examination of the rectum (sometimes): The rectovaginal examination is part of the gynecological examination when necessary. The gynecologist inserts the index finger into the vagina and the middle finger into the rectum to examine the back wall of the vagina for abnormal growths or thickness. The gynecologist can examine the rectum for hemorrhoids, fissures, polyps, and lumps.
• Breast examination is included in the gynecology examination.
Urgent gynecological examination and evaluation are required in cases such as excessive bleeding, suspected miscarriage, fever, severe abdominal or groin pain, genital organ injuries due to falls and genital trauma, ectopic pregnancy, severe menstrual pain and swelling, itching, mass, and wounds in the external genital organs.
Routine annual gynecological examinations are recommended for women for control purposes even when there are no complaints or symptoms. There is also the opinion that an annual examination will not be required in women who do not have any complaints and do not carry any risk of gynecological problems.
Considering that the smear test can also be taken during the gynecological examination, which will be performed for routine control purposes and without complaints, it is more appropriate to do it on the days following the end of menstruation and without having sexual intercourse for the last 2-3 days.
When there is a complaint, it does not matter what day of the menstrual period it is. In addition, if some diseases will be evaluated or infertility follow-up and treatment will be carried out, examinations can be planned on different days of menstruation.
However, there are cases when it’s best to see a gynecologist during a period:
The following may help make the pelvic exam easier:
If you have symptoms such as—pain in the lower abdomen, menstrual irregularities, abnormal bleeding, abnormal vaginal discharge, itching, pelvic pain, or pain during sex, absence or delay of menstruation, painful menstruation, non-menstrual bleeding, swelling, itching, sores in the genitals, menstruation not yet started despite reaching the age of 16, hair growth, and child desire- a pelvic exam can help your gynecologist to diagnose the issue.
As part of a pelvic procedure —Pelvic exams are done during the insertion of an intrauterine device (IUD) or having an endometrial biopsy.
During pregnancy —A pelvic exam is typically performed at your first prenatal care visit.
History of gynecological conditions such as cervical abnormal cells may require regular screenings.
In cases such as exposure to sexually transmitted diseases.
With gynecological examinations and controls, a special medical service is offered to women aiming to protect their sexual and reproductive health.
In this way, diseases are protected, early diagnosis and treatment of cancers and infections affecting the reproductive organs, and prevention of problems such as infertility that may occur later are provided. By achieving complete physical and mental health, the quality of life increases.
The potential benefits of a routine pelvic exam include:
Cervical cancer screening is done with Pap Smear scans and human papillomavirus (HPV) high-risk type screening. Pap smear screenings provide early diagnosis and treatment of cervical cancer.
How often the woman should have cervical cancer screening and which tests she should have depended on age and health history. At age 21, most women should start having tests to screen for cervical cancer with a Pap smear test.
Some diagnostic tests may be performed during or after the gynecological examination. Diagnostic tests such as pipel sampling from the inner wall of the uterus, colposcopy and biopsy, saline infusion sonography, hysteroscopy, hysterosalpingography, diagnostic laparoscopy, pelvic tomography, MR, PET...
After the gynecological examination, it may be necessary to wait for the test results. After the treatment is planned, it is necessary to use the drugs given completely and correctly, to follow the recommendations carefully, and to go on time if called for control.