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Gynaecological examinations

by the editorial team Published on 18 September 2008
Gynaecological examinations

Our guide to routine gynaecological examinations, their use and what to expect.

Routine gynaelogical examination
An examination may involve:
- A general examination to assess the patient’s body, weight and height, any changes in general health and problems in other areas.
- An abdominal examination. The doctor will feel your stomach to detect any pain or tumours.
- A breast examination to detect the presence of cysts or lumps.
- A look at the perineum to check for changes caused by hormones and infections, and to assess the after-effects of childbirth (tears, episiotomy and fistula).
- An examination of the pelvis, which is carried out with a vaginal speculum that lets the doctor feel around.
The gynaecologist will examine the vulva first, then the cervix and ovaries. He/she will introduce a speculum (a long, straight metal or plastic instrument that spreads the vaginal walls) to allow a view into the vagina and cervix to check for infections. At the end, he or she will feel inside the vagina (with gloved hands, of course) to check your internal genital organs, pressing down lightly on your abdomen.
- At this moment a smear (PAP) test can be carried out. Cells from the cervix and deep inside the vagina are collected with a swab and analysed for any problems.
A smear test is recommended every 2 or 3 years for women over 20.

Further examinations
A cytohistological examination or biopsy can precisely diagnose uterus problems. There are three kinds of biopsy:
Cervical biopsy: if a smear test or colposcopy reveal abnormalites of the cervix, a piece of flesh from the cervix is analysed by a specialist.
Endometrial biopsy: this is carried out in menopausal women who suffer abnormal vaginal bleeding. It could be a sign of infection, hormonal imbalance, pre-cancerous changes or even cancer of the uterus.
Vulva and vaginal biopsy: usually carried out under local anaesthetic. A biopsy may take place if it's hard to diagnose lesions in the area, especially on older women who have a higher risk of cancer of the vulva. A vaginal biopsy must be done if there is a visible lesion (this can be carried out during a colposcopy).

Endoscopic examinations
Vulvoscopy: the vulva is examined using a kind of magnifying glass which helps to view small lesions and to locate areas which may need a biopsy. This examination is quite rare.
Colposcopy: a thorough exam carried out with a microscope at the entrance to the cervix. There are no risks and it is a key examination in the diagnosis of the early signs of cervial cancer.
Hysteroscopy: this examines the wall of the uterus, to view the interior of the uterine cavity. No anaesthetic is required.
Coelioscopy: an endoscopic exploration of the abdominal cavity carried out under local anaesthetic. It can diagnose ectopic pregnancy, tumours or pelvic pain.

X-ray examinations
Hysterosalpingography: an X-ray of the uterus and Fallopian tubes which supplies essential information about the endomentry, body and tubes.
Pelvic scan: in the past this was used to check pelvic mass and to assess invasive ganglions. The scan has been replaced by the MRI scan.
Ultrasound: more useful in obstetrics than in gynaecology, but can still be used to visualise the ovaries or to intervene if there is a tumour around the pelvis.