Gynecologic Examination Istanbul

Gynecologic Examination

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.

When should a girl have her first pelvic exam?

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.

What is a complete gynecological exam?

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.

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.

What are the steps for gynecological examination?

Gynecologic Examination

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.

What are gynecologic emergencies?

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.

How often should a woman have a gynecological exam?

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.

Can a pelvic exam be done during the menstrual period?

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:

• Intense period pain,
• Irregular periods,
• Heavy periods that last for a week or more,
• Getting an intrauterine device (IUD) inserted — Some gynecologists suggest that their patients come in for an IUD insertion appointment during their period because the cervix is more open, making the process easier.
• Infertility workup and treatments: Basic hormone tests and evaluation of the ovaries before starting infertility treatments.

How to Prepare for a Visit to the Gynecologist?

The following may help make the pelvic exam easier:

• It is better not to schedule the appointment during the menstrual period.
• At least 2 days before the examination, avoid sexual intercourse, vaginal creams, suppositories, medicines, vaginal douches, and tampons.
• While coming for a gynecological examination, care should be taken to wear easily removable clothes and underwear.
• Taking the necessary points into consideration and taking notes before the examination makes the appointment more efficient. Attention should be paid to the completeness of the information given to the doctor and the complaints conveyed. Giving wrong or incomplete information negatively affects the treatment. All private information provided will remain confidential.
• Before the examination, you will be asked to empty the bladder.
• You can use relaxation techniques such as deep breathing, guided imagery, and mindfulness during gynecologic exams. Also, throughout the exam, you can close your eyes, inhale through your nose for four seconds and then exhale through your mouth for four seconds.
• Asking as many questions as needed and seeking advice will help to make the exam easier.
• The gynecologist will talk through the exam step by step so that the woman is prepared for what is about to happen.
• The gynecologist will always ask permission before touching.
• The gynecologist can use different positions and insert a smaller speculum to ease discomfort or pain.
• The patient can ask to stop the exam at any time.

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.

Why Is Gynecological Examination Important?

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:

• Possible early detection of treatable conditions, such as infections or cancer,
• Detection of other problems, such as changes to the skin in your pelvic area,
• A better understanding of your body,
• Reassurance about your sexual and reproductive health.

Importance Of Pap Smear Test

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.

What diagnostic tests can be done during or after a gynecologic examination?

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...

What should be taken care of after a gynecologic examination?

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.

RECOMMENDATIONS

• A gynecologic examination should be performed whenever a woman presents with pelvic symptoms. The most common gynecologic concerns relate to vaginal discharge, abnormal bleeding, pain, urinary problems, breast disorders, sexual dysfunction, and infertility. When a woman complaints about one of these issues, detailed questioning can guide further evaluation and diagnosis.
• There is no defined age at which the first gynecologic examination is performed, as this depends upon the probability of identifying a gynecologic problem.
• In general, gynecological examinations including Pap smear test and screening for genital infections are performed once a year in adult women without complaints. The purpose of these examinations is also to screen for gynecological cancers.  Screening examinations are done yearly or periodically, and the preferred examination frequency should be decided by the woman and her gynecologist.