1. Full body examination
This includes measuring body temperature, pulse, respiration, blood pressure, and if necessary, measuring height and weight. Other examinations are the same as other internal medicine examinations.
2. Abdominal examination
It is an important component department that should undergo systematic observation, touch, percussion, and listening before pelvic examination. Observe the appearance of the abdomen, whether there is a dragon riding or frog like abdomen, whether there are scars on the abdominal wall, varicose veins, etc. Outpatient abdominal wall softness and tension, whether there is tenderness, rebound tenderness or muscle tension, and whether a lump can be palpated. Touch the liver, spleen, and kidneys for any enlargement or tenderness. Pay attention to the presence of mobile voiced sounds during percussion examination.



3. Pelvic examination
(1) External genital examination to observe the development of the external genitalia, the amount and distribution of pubic hair. Normal external genitalia, with pubic hair pointed downwards and distributed in a triangular shape. There are no ulcers, dermatitis, growths, or hypopigmentation in the perineum area. The mucosa near the urethral opening is light pink with no growths. Married women have old cracks in their hymen, and postpartum women may have old cracks in their hymen and perineum, or there may be incisions in the perineum. When necessary, doctors sometimes instruct patients to hold their breath downwards and observe for any vaginal wall protrusion, uterine prolapse, or urinary incontinence. If there are any abnormalities, they will be recorded in detail.
(2) Vaginal examination is performed using a speculum: the movements should be gentle and avoid bleeding caused by friction as much as possible. The normal vaginal wall mucosa is pale and powdery, with folds, no ulcers, growths, cysts, vaginal septum, or congenital abnormalities such as double vaginas. Normal vaginal discharge is egg white or white paste like, without any fishy odor, with a small amount, but increases during ovulation and pregnancy. If there are abnormalities, patients may experience local itching, burning sensation, etc. If there is abnormal vaginal discharge, the secretion can be removed at this time for smear detection of trichomonas, candida, gonorrhea, and clue cells. If necessary, bacterial culture can be performed. White discharge is a mixture of vaginal mucosal exudate, cervical canal and endometrial glandular secretions, and its formation is related to the action of estrogen.



In general, the cleanliness of vaginal discharge can be divided into four levels:
Grade I: A large number of vaginal epithelial cells and vaginal bacteria can be seen under the microscope.
Grade II: Under the microscope, there are vaginal epithelial cells, a small amount of white blood cells, and some vaginal bacteria. There may be some miscellaneous bacteria or pus cells.
Grade III: Under the microscope, there is a small amount of vaginal bacteria, as well as a large number of pus cells and miscellaneous bacteria.
Grade IV: No vaginal bacteria were seen under the microscope, except for a small number of epithelial cells, mainly consisting of pus cells and miscellaneous bacteria.
Note: Grades I-II are normal, while grades III-IV are abnormal vaginal discharge, indicating vaginal inflammation.
(3) Cervical examination shows a normal protrusion around the cervix with a hole in the middle. Unpartum women are round in shape, while postpartum women are in a "one" shape, tough in texture, flesh red in color, and have a smooth surface. If it is normal during examination, it refers to light, texture, no itching or pain, etc. If abnormalities are found, the grading of erosion (mild, moderate, severe), the degree of cervical hypertrophy, and the size and location of vegetation will be described in detail. At this time, cervical cancer prevention scraping cytology examination is feasible, which is the main method of cancer prevention screening and has important value in diagnosing precancerous lesions and early cervical cancer.



(4) The examiner for uterine and accessory examination should wear gloves, apply lubricant to the middle finger of the index finger, and gently enter the vagina through the vaginal opening along the posterior wall with two or one fingers. The other hand should be used to assist in the examination in the abdomen, which is called double examination. Dual diagnosis is the most important item in pelvic examination. The purpose is to palpate the vagina, cervix, uterus, adnexa, uterine ligaments, and parametrial connective tissue, as well as other organs and tissues in the pelvic cavity for abnormalities. A normal uterus is pear shaped, measuring 7-8cm in length, 4-5cm in width, and 2-3cm in thickness. It has a medium hardness and good fluidity. The ovaries and fallopian tubes are collectively referred to as the "adnexa", which may cause a slight sour and swollen sensation when touched. Normal fallopian tubes cannot be touched. If the patient feels pain and sadness when pushing the cervix upwards or on both sides, it is called cervical lifting pain, which is a manifestation of pelvic visceral organ disease. If included, attention should be paid to location, size, appearance, fluidity, relationship with the uterus, and tenderness.
(5) Triple examination refers to the combined examination of the abdomen, vagina, and rectum, which is a supplementary examination to the double examination. Can understand the size of the uterus that tilts and bends backwards; Whether there are lesions in the posterior wall of the uterus, rectovaginal concavity, or uterosacral ligaments, especially the extent of cancer infiltration, and whether there are lesions in the vaginal rectal septum, anterior sacrum, or rectum.
Rectal abdominal examination: Used for patients without a history of sexual intercourse, vaginal atresia, or other reasons who are not suitable for dual examination.
(6) The results of pelvic examination are recorded in the following order of anatomical locations through pelvic examination External genitalia: Development status, marital and childbirth styles, and if there are abnormalities, detailed descriptions should be provided Vagina: whether it is unobstructed, condition of vaginal mucosa, secretion volume, color, characteristics, and whether there is any odor Cervical: size, hardness, presence or absence of epithelial ectopia, tearing, polyps, glandular cysts, contact bleeding, and pain Uterine body: position, size, hardness, fluidity, and tenderness, etc Fallopian tubes and ovaries: presence or absence of lumps, thickening, or tenderness. If a lump is palpable, record its location, size, hardness, smoothness of the surface, fluidity, tenderness, and relationship with the uterus and pelvic wall. The left and right conditions should be recorded separately.



(7) Basic requirements for pelvic examination: ① Soft and gentle movements; ② Before the examination, instruct the patient to empty the bladder. For those with full stools, the examination should be conducted after defecation Generally, pelvic examinations should be avoided during menstruation, except for those with abnormal bleeding. Disinfect the external genitalia and use sterile gloves and equipment before examination to prevent infection; ④ Every time someone is checked, the hip pad should be replaced to prevent cross infection; ⑤ Bladder lithotomy position, with the examiner facing the patient and standing between their legs. Critical illness should not be moved and can be checked on the hospital bed; ⑥ For unmarried patients who deny sexual activity, double examination and vaginal speculum examination are prohibited, and anal and abdominal examination should be performed. If necessary, with the consent of the individual and their family members, they may try to enter slowly with an index finger or conduct the examination under anesthesia The temperature in the gynecological examination room should be moderate, and attention should be paid to keeping warm when it is cold; The environment should be as quiet as possible to make patients feel peaceful and at ease Avoid pelvic examination during menstruation. If abnormal vaginal bleeding requires gynecological examination, the external genitalia should be disinfected first, and sterile instruments and gloves should be used for examination When male doctors examine unmarried patients, other women should be present to alleviate the patient's nervousness and avoid unnecessary misunderstandings For patients with suspected uterine or adnexal lesions and abdominal wall hypertrophy or high tension, if pelvic examination cannot clear and understand the condition of the uterus and adnexa, B-mode ultrasound examination should be performed. If necessary, gynecological examination can be performed under anesthesia.





Source of Reading: Kang Zhiyuan www.kzyyl.com