Comprehensive gynaecologic examination

Complete gynaecological examination includes:

• Gynaecologist consultation;
• Ultrasound scan;
• Blood test (as necessary).

Complete gynaecological examination normally consists of the following steps:

1. Patient and doctor conversation

Usually, the patient is asked about her state of health, complaints, used contraception, menstrual cycle, its duration and special aspects, the first of the latest period is established. At the first visit the patient should tell about all chronic and past conditions, surgeries, past pregnancies, births (if any) special aspects, etc.

2. Examination in the chair

• Examination of external reproductive organs, lymph nodes.
• Examination with mirror (the doctor inserts a sterile instrument, i.e. a mirror, into the vagina and uses it to examine the vagina and cervix; smears are taken). This method allows examination of the womb and cervix structure and detect possible conditions. Normally this procedure does not bring any discomfort, although it may appear if there is an abnormality of if a woman is scared or stressed which may cause tension and make the exam more difficult.
• Vaginal examination is performed if a woman is sexually active. The doctor inserts middle and index finger into the woman’s vagina, places the other hand on the front abdominal wall and palpates the uterus and uterine appendages. This method allows diagnosing uterine, ovarian and tubal conditions, as well detecting pregnancy. Normally this procedure does not bring any discomfort, although it may appear if there is an abnormality of if a woman is scared or stressed making her muscle tense, which interferes with the exam.
• For women who have never had sex the exam is conducted differently: the doctor inserts the index finger of one hand into the woman’s rectum and placing the other hand on the front abdominal wall palpates the uterus and uterine appendages.
• In some cases, rectovaginal examination (through the vagina and rectum simultaneously) is done as an additional method and is recommended for elderly women.

3. Ultrasound scan

Transabdominal (through the front abdominal wall) or transvaginal (through vagina) ultrasound scan of the organs of small pelvis. Transvaginal ultrasound can detect benign and malignant uterine and ovarian tumours, urethral pathologies, inflammatory processes, cause o urination disorders or urinary incontinence, early pregnancy and also can monitor ovarian follicular apparatus during infertility treatment.

Successful transabdominal ultrasound requires full bladder,which means that it is recommended to drink 500-700 ml of liquid 2-3 hours before the examination. This examination is recommended to be done once a year as prophylaxis even if there are no complaints. If any abnormality is discovered, your doctor will recommend further examination frequency.

4. Breast examination

It is a mandatory examination as breasts are hormone dependent organs.Woman can lie or stand during the exam. The doctor will carefully examine the breasts looking at their shape, structure, symmetry, tenderness and other parameters.

5. Testing as necessary

Full blood count (rhesus factor, rhesus antibodies [important for pregnant women!]), urine test, biochemical blood panel, coagulation profile, sex hormone and other hormone analysis, tests for infections, etc. – your doctor will determine necessary tests and when they should be done.

6. Smears (cervical screening and microbiology)

• Cervical screening

Cervical screening is an effective cervical diagnosis or change detection method, as such changes may be early signs of cervical cancer. Cervical screening allows obtaining information about changes (including precancerous) in the cervix (the narrowest and lowest part of the uterus and tumour signs. Gynaecologist takes smear using a scrape or a special brush carefully separating a few cells from the surface of the cervix. After that the sample is studied in the lab to identify any early changes. Cervical screening is done once a year, but in many European countries if the cervical screening reveals no problems, the next will be in three years, as it is considered that cervical cancer does not develop that quickly.

• Microbiology

Or vaginal microflora test. Gynaecologist takes smear from the vaginal fornix using a scrape or a special brush. After that the cells are examined in a lab. This test helps detect vaginal inflammations and infections. It can also detect fungi, gonorrhoea, trichomonas, staphylococci and other infectious agents.

7. Other examination methods

E.g. tubal patency test (hysterosalpingogram), hysteroscopy, etc., as necessary.