Research of internal genital organs - Causes, symptoms and treatment. MF.

After examination of the external genitalia, the examination is carried out with the help of mirrors, as the preliminary finger examination can change the nature of the vaginal discharge and injure the mucous membrane of the cervix and vagina, which makes the results of the examination invalid and prevents the obtaining of the correct diagnostic data using endoscopic research methods( colposcopy, cervicoscopy, microcollection, etc.).

Inspection of the vagina and cervix is ​​performed with the help of vaginal mirrors( cylindrical, folding, spoon-shaped, etc.).Determine the condition of the walls of the vagina( the nature of folding and the color of the mucous membrane, the presence of ulcers, growths, tumors, etc.), the vault and cervix( size, shape - cylindrical, conical, in nulliparous outer canal cervical canal round,various pathological conditions - ruptures, erosion, epithelial dysplasia, submucosal endometriosis, inversion of the mucous membrane, tumors, etc.), as well as the nature of the vaginal discharge.

For diagnostic purposes, as well as for various manipulations on the cervix, the latter is fixed with bullet forceps, each having one sharp tooth on each branch, or Muzo forceps that have two prongs on each branch and approaching the entrance to the vagina.

Vaginal examination should be combined( bimanual).Pushing the labia with the thumb and forefinger of the left hand, the doctor enters the index finger( and then the middle one) into the vagina, paying attention to the sensitivity, the width of the vaginal opening, the elasticity of its walls. With the other hand, he fixes the organ under examination( uterus, appendages) through the abdominal wall or tries to probe one or another region of the small pelvis. The study is performed with one index finger or two fingers - the index and the middle finger.

It should be noted that the most sensitive places are the clitoris and the front wall of the vagina in the area of ​​the urethra, so do not press on this area;The fingers should slide along the back wall of the vagina. If the introduction of fingers into the vagina is difficult, it is necessary to take the perineum down, pre-lubricate fingers with an indifferent fat( petroleum jelly).

Inserting fingers deep into the vagina, determine the condition of the mucous membrane of the vagina( the degree of humidity, the presence of growths, roughness, scars, dislocation), the presence of tumors, septa( double vagina);exclude bartholinite. Through the front wall of the vagina, the urethra can be probed for a considerable length during infiltration.

Then the finger finds the vaginal part of the cervix and determines its shape( conical, cylindrical), the size, shape of the external uterine pharynx, its opening( with ischemic-cervical insufficiency), the presence of ruptures and scars on the neck after delivery, tumors. With dysplasia of the cervix, its surface sometimes seems velvety;ovula Nabothi are probed in the form of small tubercles. By the location of the cervix, sometimes you can judge the displacement of the uterus.

In the future, proceed to bimanual( combined) vaginal-abdominal examination, which is the main type of gynecological examination, since it allows to establish the position, size, shape of the uterus, to determine the condition of the appendages, pelvic peritoneum and cellulose.

Bimanual examination is a continuation of the vaginal study. In this case, one arm( internal) is in the vagina, and the other( external) - above the pubis. In bimanual examination, one must touch organs and tissues not with fingertips, but with as much as possible with their entire surface.

First examine the uterus. To determine its position, shape, size and consistency, fingers inserted into the vagina fix the vaginal part of the uterus, raising it slightly upward and anteriorly and thus bringing the uterus to the anterior abdominal wall. Normally the uterus is located in the small pelvis along the median line, at the same distance from the pubic articulation and the sacrum, as well as from the side walls of the pelvis. In the vertical position of the woman, the bottom of the uterus is turned upwards and forwards and does not go beyond the plane of the entrance to the small pelvis, and the cervix is ​​turned downwards and backwards. Between the neck and the body of the uterus there is an angle open anteriorly. However, there are a number of deviations from this normal( typical) position of the uterus in the form of various kinks and its displacement in one direction or another, which makes it necessary to change the method of investigation.

Normally, the uterus of an adult woman has the shape of a pear squashed front to back;its surface is even. When you feel, the uterus is painless and shifts in all directions. Physiological reduction of the uterus is observed in the climacteric period. Pathological conditions accompanied by a decrease in the uterus include infantilism and atrophy of the uterus( with prolonged breastfeeding, after prompt removal of the ovaries).

The consistency of the uterus is normally tauto-elastic, the uterus wall is softened during pregnancy, and the uterine wall is compacted. In some cases, the uterus may fluctuate. This is typical for hematometers and piometers.

After the examination, the uterus starts palpation of the appendages( ovaries and fallopian tubes).Unchanged uterine tubes are thin and soft, usually they are not probed. Bundles, fiber and appendages of the uterus are normally so soft and supple that they can not be palpable.

Sactosalpinks is felt in the form of an elongated, mobile formation, widening toward the funnel. The pyosalpinx is more often less mobile or fixed with spikes.

Often, in pathological processes, the position of the fallopian tubes varies, they can be soldered by spikes in front or behind the uterus, sometimes even on the opposite side. The ovaries are well probed in women of reduced nutrition in the form of an amygdala-shaped body measuring 3x4 cm;they are sufficiently mobile and sensitive. Ovaries are usually enlarged before ovulation and during pregnancy. The right ovary is more accessible to palpation than the left one.

Peripheral fiber( parameters) and serous membrane of the uterus( perimetrium) are palpable only if they contain an infiltrate( cancer or inflammatory), adhesions or exudate.

When vaginal examination is not possible( in virgins, with vaginal atresia), as well as in tumor formations, a rectal combined study is indicated.

The study is performed on a gynecological chair in a rubber glove or fingertip, oiled with petroleum jelly. It is necessary to prescribe a cleansing enema.

A combined rectal-vaginal-abdominal examination is indicated if there are suspicions of pathological processes in the vaginal wall, rectum, or in the rectal-vaginal septum.