Gynecological check
procedure
This is what it says at the beginning of a gynecological examination conversation with the gynecologist. They first ask for important information about their patient, for example Previous illnesses, previous pregnancies and / or births, allergies and possible current complaints. If there are complaints, they will be explained again in the conversation and important questions asked.
This is followed by the gynecological examination. While the doctor is laying out the necessary materials and preparing the examination room, the patient undresses in a small, separate area below, or in a changing room. Then she takes a seat on the gynecological chair in the so-called lithotomy position. The woman is in a half-sitting, half-lying position with her legs spread and slightly bent. The doctor will now start with the Inspect the genital region from the outside and look for changes in the skin, swelling, redness, or discharge.
Subsequently he feels for lymph nodes in the groin area and palpates the lower abdomen from the outside for tenderness and other abnormalities. This is followed by a vaginal examination. The doctor needs a preheated speculum, which he inserts into the vagina and then opens. This will stretch the vagina and the cervix can be judged.
For general cancer screening, the doctor takes a kind of cotton swab and removes one Smear from the portio, the lower part of the uteruswhere the cervix is also located. The streaked cells are streaked onto a slide. Then the doctor takes a small brush with which Smear from the cervix is taken. This can be a bit uncomfortable for the woman. These cells are also spread on a slide for later assessment in the laboratory. The speculum can now be removed again.
Another follows vaginal palpation examination. The doctor carefully inserts two fingers and at the same time feels with the other hand from the lower abdomen towards the inserted fingers. The bladder, uterus and ovaries can be palpated. For example, attention is paid to whether the patient feels pain in one area.
The gynecological examination also includes a rectal examination in which the anal region is palpated with a finger. The patient can then get dressed again, but now takes off her upper part so that the breast examination can still be carried out. The doctor feels both breasts and the lymph nodes in the neck and armpit area for abnormalities.
Depending on whether the patient has symptoms, the gynecological examination can be expanded to include various aspects. For example, an ultrasound can be performed from the abdomen or through the vagina in order to be able to assess the uterus and ovaries more precisely.
Gynecological examination in children
A pelvic exam may also be necessary in children. The most common reason for an investigation is suspicion of physical and sexual abuse.
The most important thing in a child's gynecological examination is the child-friendly handling of the situation, taking into account the age of the child. The child needs to be given a lot of time to get used to the situation. They should also be actively involved in the examination process and, for example, take off their clothes themselves if possible. So it gets the feeling of being able to control the situation itself.
In the case of older children, it is also particularly important that a same-sex examiner is chosen, as the shame in front of the opposite sex can be very pronounced. All examination steps should also be clearly announced to the child. If the child refuses an examination, it should not be forced, but should be convinced of it with time and patience.
In children, certain body positions are suitable for the gynecological examination, for example the Knee-elbow posturein which both the genital and anal region can be easily inspected. With this position, however, it should be noted that it can recall possible sexually traumatic events, as many cases of abuse are associated with such a body position of the child.
To secure sperm traces, the child should in the first 24 hours must be examined after the suspected attack, otherwise possible traces can no longer be determined with certainty. Smears are taken from the mouth, vagina and anal region and examined for pathogens and sperm. Since the sperm traces do not necessarily have to be in the child's body orifices, the child's clothing and, if possible, the environment in which the attack took place should also be examined for such traces.
However, suspicion of sexual abuse is not always the reason for a gynecological examination in children. Children can also suffer from gynecological diseases, such as bacterial or fungal infections (see also: Vaginal fungus). A pelvic exam may then be required. There are also gynecologists who specialize in pediatric gynecology. In order to make the examination situation as pleasant as possible for the little patient, the treatment rooms are designed to be suitable for children and the doctor takes enough time for the child. Very anxious children may find it helpful to sit on a caregiver's lap during the examination.
What can you do about fear?
A pelvic exam is not a happy event for most women. Some women are even afraid of going to the gynecologist, as they find sitting on the gynecological chair particularly uncomfortable and feel at the mercy of the doctor. However, there are a few little tips and tricks that you can use to make the trip to the gynecologist easier.
First of all, it is important to find the right doctor for yourself. It should be someone you feel comfortable with and with whom you have the feeling that you can confide in yourself. For this purpose, a non-binding appointment can first be made with a gynecologist, during which only a preliminary discussion is held so that the doctor and patient can get to know each other first. The gynecological examination can then take place on a second appointment if the patient has the feeling that she has arrived at the right doctor. Otherwise she can turn to another practice.
In addition, it is always possible to take someone you trust with you to the doctor, who is either present during the conversation or during the examination and who supports the patient. This has a calming effect on many women. The confidant can stand half behind the patient sitting on the gynecological chair, so that she can hold her hand, for example, but cannot see the patient's intimate area.
The woman can alleviate the feeling of being naked and exposed by wearing a long top, skirt or dress on the day of the examination. These items of clothing can be left on during the vaginal examination and cover the genital area from above, but do not restrict the doctor's view.
You can also ask the doctor to explain the examination steps in detail so that you always know exactly what will happen next. This can reduce anxiety and excitement. Ultimately, the woman should keep in mind that the gynecological examination serves her health and that nothing bad can actually happen. The doctor examines a large number of women every day and is only interested in the health of the patients. He / she does not care what the patient looks like below or whether she is shaved or not.
Remember that the examination is over within a few minutes and that afterwards you can be proud that you have mastered the examination and taken an important step for your health.
Gynecological examination in virgins
A pelvic exam can also be done while a virgin. The gynecologist will clarify in the first interview whether the girl or woman has ever had sexual intercourse. If this is not the case, the examination is carried out with particular care and using smaller instruments.
The smear can be omitted in girls who have not yet had sexual intercourse. However, since cancer screening is an important examination, the smear should be done after a certain age.The same applies if the patient has complaints, since a smear is then important in order to be able to identify any pathogens and initiate appropriate treatment.
The hymen usually does not cover the entire vaginal entrance. So it is quite possible to take a smear without damaging the hymen. Since many girls who are still virgins are particularly afraid of their first visit to the gynecologist, it is important that the doctor is particularly sensitive, takes their time and makes the examination as pleasant as possible.
Read more on the topic: The first visit to the gynecologist
Special features in pregnancy
Belong in pregnancy regular gynecological examinations this is essential to ensure a smooth pregnancy and to identify risks for mother and child at an early stage.
After the pregnancy has been determined, a general gynecological examination is carried out, in which the pregnant woman screened for specific medical conditions that could be dangerous for the unborn child, for example a Chlamydial infection, toxoplasmosis, syphilis and HIV. In addition, it is checked whether the pregnant woman has an adequate defense against rubella having. This should be done by the Childhood vaccinations be the case. Otherwise, rubella infection during pregnancy could be dangerous.
For more information, see: Infections in pregnancy
Ultrasonic
An ultrasound can also be done as part of a gynecological examination. Both the Ultrasound examination through the abdominal wall or through the vagina as well as the Ultrasound scan of the breast can be part of a gynecological examination.
Ultrasound is usually used when the doctor wants to assess the uterus or ovaries based on certain symptoms of the patient. If the patient wishes to have an ultrasound examination as a preventive measure without a special reason, so it is usually not a cash benefitso that the woman has to bear the costs herself.
The ultrasound examination can be carried out with a transducer through the abdominal wall. However, the ovaries, in particular, are more visible when the vaginal transducer is used. This is a pen-shaped transducer that is covered with a protective cover and inserted into the patient's vagina. The investigation is normal not painful. Ovaries and uterus can be easily visualized with this method.
Ultimately, the ultrasound can also be used by the gynecologist for breast examinations if changes in the breast tissue are suspected. On the one hand, breast ultrasound can be used as part of breast cancer screening in women with very dense breast tissue; on the other hand, it is also often used in young women in whom the palpation examination of the breast revealed abnormalities and who are reluctant to the X-rays during the classic mammography want to suspend.
Regular gynecological examinations during pregnancy always include Survey of weight and waist circumference the pregnant woman as well as one Blood pressure measurement. The pregnant woman's urine is also examined for increased protein levels or sugar excretion. Finally, means Ultrasound the baby's level of development judged. Later, the organs of the unborn child and its gender can also be assessed and any malformations identified.
For more information, see: Ultrasound in pregnancy
A pelvic exam should normally be performed no pain prepare. The smear from the cervix can be done for some women somewhat uncomfortable but usually does not cause persistent pain.
If there is an infection, such as a Fungal infection of the vagina or other inflammatory processes, it can be painful if the gynecologist does this Speculum introduces or carries out the palpation examination. The pain is an important symptom that the doctor pays attention to in order to further classify the patient's clinical picture. Nevertheless, the doctor tries to give the patient as little pain as possible.
Normal cancer screening, to which the patient appears without feeling any other symptoms, is usually completely pain-free. If pain occurs afterwards, it could be that minor injuries were accidentally made during the examination. However, the pain should then subside quickly. Should the complaints persist, so the gynecologist should be visited again.
Cost of a gynecological examination
The cost of the pelvic exam will be usually from the health insurance company accepted. Every woman has the right to a regular cancer check-up and can also take advantage of a gynecological examination at any time if she has complaints, without having to pay for it yourself.
In the case of privately insured patients, the patient may have to pay in advance for the examination. However, after submitting the invoice, she gets the money back from her health insurance company. All examinations that are medically required are therefore covered by the health insurance fund. Desired services must be paid for yourself, since these additional examinations are not necessarily always an advantage. M.Sometimes they give false positive results and only lead to unnecessary uncertainty. The use of hormonal IUDs or other contraceptive methods (for example Three-month syringeAs a rule, the patient has to pay for it herself.
