Bimanual vaginal examination

Vaginal (internal) examination is performed by the middle and index fingers of one hand (usually the right one). With the other hand, you must first dilute the labia. Vaginal examination allows you to determine the condition of the pelvic floor muscles, large glands of the vestibule, urethra, vagina (volume, stretch, soreness, the presence of pathological processes, the state of the vaults), the vaginal part of the cervix (position, size, shape, consistency, surface, mobility, soreness, state of the external throat).

In the future, the study is continued with two hands (inserted into the vagina and the other hand through the anterior abdominal wall).

Two-hand vaginal (bimanual, combined, vaginal-abdominal) study is the main method of recognizing diseases of the uterus, appendages, pelvic peritoneum and cellulose. In the study of the uterus determine its position (inclination, kink, etc.), size, shape, consistency, mobility, soreness. Moving the outer arm to the side walls of the pelvis (alternately), and the inner arm into the lateral arches of the vagina, examine the appendages of the uterus. Unchanged fallopian tubes and ovaries are usually not probed.

By brushing the second hand from the side of the abdominal wall, palpation of the pelvic organs is carried out according to certain rules. In this case it is possible to establish the width of the entrance to the vagina, the state of the perineum, the pelvic floor muscles, the length of the vagina, the depth of the vaginal arches, the length and condition of the vaginal part of the cervix, the body of the uterus (position, size, consistency, mobility, soreness, shape, etc.). And appendages (fallopian tubes and ovaries). This study can also give an idea of the state of the pelvic wall (bony exostosis).

To obtain the most complete information, you need to follow a certain sequence. The diseases of the urethra are excluded, its condition is revealed (thickened, compacted, painful). The capacity of the vagina, the degree of folding of the mucosa, the condition of its walls are estimated.

The next step is to study the vaginal part of the cervix. Its normal size is approximately the nail phalanx of the thumb.

In women giving birth, the cervix of the uterus is cylindrical, in the nulliparous - conical. The consistency of the cervical tissues is rather dense. The condition of the external pharyngeal is of significant importance (in the norm it is closed).

After this, the uterus is examined . Its shape, size, consistency, displacement, sensitivity during palpation and movement are determined.

Uterine enlargement may indicate pregnancy or swelling. Different consistency, asymmetry of the uterus, combined with its increase, can be associated with the tumor process. Restriction of uterine mobility is most often caused by an inflammatory or adhesive process.

The next stage is the establishment of the condition of the uterine appendages. To do this, the test fingers are alternately translated into the lateral arches. Unchanged appendages of the uterus can be palpated in a lean woman and with a good relaxation of the anterior abdominal wall.

If the appendages are palpable, pay attention to their size, shape, sharpness of the contours, the nature of the surface, consistency, mobility and sensitivity.

In acute inflammatory diseases of the uterine appendages, the internal investigation is painful, the contours of the palpable organs are indistinct, it is often not possible to isolate the palpation of the uterus from a common inflammatory conglomerate. With chronic inflammation, the altered appendages are palpated more clearly, have less soreness, are located in the adhesions that limit their movement.

Ovarian cysts are more often unilateral, palpable as a clear, rounded formation with a smooth surface, sufficiently mobile and painless.

Ovarian cysts of a more dense, sometimes uneven consistency, the movement of the tumor can be limited.

With advanced forms of ovarian cancer in the small pelvis, massive immobile tumor conglomerates are detected. Propalpate the uterus is not possible.

Then proceed to the study of the parameters. Usually the tissues of the parameter are not felt by the fingers. In inflammatory diseases of the sexual organs, cellulose can be presented as edematous, sharply painful, in some cases it becomes denser (after previous inflammation). Assessment of the condition of the parameters is necessary for malignant neoplasms, since metastasis in cervical cancer occurs through the lymphatic pathways to the lymph nodes on the side walls of the pelvis. In this case, the fiber is compacted, and the cervix is pulled upward or to one of the lateral walls of the pelvis.

Some changes can be detected in sacro-uterine ligaments (in chronic inflammatory processes with predominance of cicatricial-adhesive changes). Ligaments (behind the uterus) are palpated with thickened, shortened, sharply painful. The movements of the uterus, especially anteriorly, cause severe soreness.

Rectal, rectal abdominal and recto-vaginal studies are performed according to indications (or as an additional study) in virgins, with atresia or stenosis of the vagina, with (inflammatory or tumor processes in the reproductive system.

Rectal examination is performed with the 2nd finger of the right hand and several fingers on the left (recto-abdominal). It helps to represent the state of the cervix, paravaginal and pararectal tissue, to establish changes in the rectum (constriction, compression by the tumor, infiltration of the walls, etc.). This study is also used in patients who did not live a sexual life (with a preserved hymen ). Rectovaginal examination is performed by inserting the 2nd finger into the vagina, and the third into the rectum. This combined study is advisable to be used for suspected pathological changes in parametric fiber and in the rectal-uterine space.

In all women with a gynecological examination for carrying out a bacteriological study, smears are taken from the urethra, vagina and cervical rope. The material is applied to two slides, separated (bottom) into three parts each - U (urethra), C (cervical canal) and V (vagina). Before taking smears, the urethra is easily massaged (outside). Alloculations are taken with a probe probe, the tip of the forceps or, preferably, by lightly scraping with a special spoon (Folkman) and applied to both slides (part M). To take the following strokes in the vagina, insert mirrors. The swab from the cervical canal is taken in the same way as from the urethra. Allocations from the posterior vaginal fornix are usually taken with a spatula (tweezers, forceps). The smears are applied to the corresponding parts of the objective glasses (C and V).

For cytological examination, all the women, first examined by a gynecologist at an outpatient clinic or admitted to a hospital, take smears and cervical canal material from the cervical surface. "

[1], [2], [3], [4]