Examination of female external genitalia

A special gynecological examination begins with an examination of the external genitalia. At the same time, attention is paid to hairiness in the pubic area and labia majora, possible pathological changes (edema, tumors, atrophy, pigmentation, etc.), the height and shape of the perineum (high, low, trough-shaped), its ruptures and their degree, the state of the genital slit (closed or gaping), prolapse of the vaginal walls (independent and during straining). When moving the genital slit apart, it is necessary to pay attention to the color of the mucous membrane of the vulva, examine the condition of the external opening of the urethra, paraurethral ducts, excretory ducts of the large glands of the vestibule of the vagina, pay attention to the nature of the vaginal discharge. After examining the external genitalia, the anal area should be examined (the presence of cracks, hemorrhoids, etc.).

The appearance and condition of the external genitalia usually correspond to age. In women who have given birth, attention is paid to the condition of the perineum and the genital slit. With normal anatomical relationships of the perineal tissues, the genital slit is closed and opens slightly only with sharp straining. If the integrity of the pelvic floor muscles is compromised, the genital slit gapes even with slight straining, and the walls of the vagina drop.

The mucous membrane of the vaginal entrance of a healthy woman is pink. In inflammatory diseases, it may be hyperemic, sometimes with the presence of purulent deposits. During pregnancy, due to stagnant plethora, the mucous membrane acquires a bluish color, the intensity of which increases with increasing pregnancy.

Hypoplasia of the labia minora and majora, pallor and dryness of the vaginal mucosa are signs of hypoestrogenism. Juiciness, cyanosis of the vulva, abundant secretion of cervical mucus are signs of increased estrogen levels. Intrauterine hyperandrogenism is indicated by hypoplasia of the labia minora, enlargement of the clitoral head, increased distance between the base of the clitoris and the external opening of the urethra (more than 2 cm) in combination with hypertrichosis. Then they proceed to examination with speculums, which is especially important in gynecology for identifying pathological changes in the vagina and cervix. Examination with vaginal speculums is a mandatory part of every gynecological examination, since many pathological conditions on the cervix and in the vagina are not accompanied by certain symptoms. It allows you to assess the condition of the vaginal mucosa (color, folding, tumor formations), its depth. On the cervix, the shape of the external os, the presence of inflammatory changes, tumor formations (polyps, exophytic cancer, etc.), and the nature of discharge from the cervical canal are determined.

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