The first gynecological examination can be quite stressful for young girls and women who are anxious and apprehensive without knowing what to expect. However, it is important to bear in mind that your gynecologist is a skilled professional, who is well versed in making you feel comfortable while quickly completing the exam with the least amount of unease and distress to the patient.
A gynecological examination can be broadly divided into three parts.
- Case History
- Physical Examination
- Other Tests and Diagnostic Investigation
Case History in a Gynecology Exam
Your gynecologist will first question you about your main complaint, which is usually the reason why you have opted to undergo a gynecological consultation. In the event that you are consulting with a gynecologist for a general check and not due to any specific complaint, there is a range of questions that he may pose to you.
Gynecology Questions during Case Taking
- Main complaint. How long has it been occurring? Where are you experiencing any sensation like pain, tenderness or discomfort? What signs and symptoms have you noticed? Why are these symptoms out of the ordinary for your specific case? What other medical investigation and/or treatment have you undergone for your primary complaint?
- Secondary complaint. Any other signs and symptoms that you may have noticed occurring simultaneously. These secondary or concomitant signs and symptoms may or may not be related to the main complaint but should be reported to your gynecologist.
- Menstrual history. The length of your menstrual cycle, heavy or light bleed with or without clots, pain, cramps or discomfort experienced during ovulation and/or menses.
- Sexual activity. How long have you been sexually active? Have you had multiple partners? Do you use any form of contraception? Have you noticed pain, bleeding or itching during and after sex? Have you contracted any venereal disease or sexually transmitted disease (STD’s) and what treatment have you had for it?
- Pregnancy. Have you ever been pregnant, experienced a miscarriage or undergone an induced medical abortion? Did you experience any difficulty with pregnancy.
- Child birth and Labor. How long was your labor? What type of delivery did you undergo (either natural vaginal birth or caesarian section? Was there an problems during labor and childbirth? Was the baby healthy? Did you breastfeed? Did you experience any post-natal depression (PND), bleeding or other gynecological disorders after giving birth?
- Family history. Any family history of breast cancer, cervical cancer or related disorders.
General Health and Medical Questions
- Past medical conditions. This involves serious medical conditions which may have occurred once off or were/are recurrent. These conditions may not be related to any gynecological disorder.
- Chronic conditions. Those conditions diagnosed by a doctor and are persisting to date for which you may have or have not undergone treatment.
- Surgical history. Type of surgery, approximate date of history, complications and success.
- General case history. Weight change, change in appetite, energy levels, sleep patterns and general medical questions.
- Lifestyle. Cigarette smoking, alcohol consumption, use of narcotic drugs, exercise and work activities.
- Drugs. Use of scheduled prescription drugs, either chronic or acute.
- Mental health. Depression, anxiety, irregular sleep patterns and other aspects related to your mental and emotional health.
- Family history. Major medical conditions that your parents, siblings or even grandparents may have suffered with.
Physical Examination in a Gynecology Consultation
General Physical Examination
- Weight and height
- Blood pressure and pulse rate
- Urine dipstick test may be conducted to check for blood, protein, glucose or hormones within the urine. This also allows you to empty your bladder for the physical examination and ultrasound later in the examination.
- Examination of the eye and lining of the inner eyelid to identify cyanosis (bluish discoloration), anemia or jaundice.
- Examination of the finger nails to identify any clubbing or cyanosis.
- Examination of the feet and lower leg to identify any swelling (edema).
- Examination of the main lymph nodes to identify any lymphadenopathy.
- Examination of the skin elasticity to check hydration, while examining if the eyes are sunken.
- Your higher functions (mental acuity) would be assessed during the case history.
Gynecological Physical Examination
- Breast examination and your gynecologist may ask you if you conduct regular breast exams on yourself and if you have noticed any ‘lumps’.
- Abdominal examination where your gynecologist will try to detect or isolate any pain, tenderness, discomfort or masses.
- Pelvic examination where the pelvis and groin area is inspected visually to identify any sores or rashes that may indicate the presence of a sexually transmitted disease (STD).
- An internal vaginal examination is usually only conducted in women who have been previously sexually active. The examination is quick and the gynecologist will also take a small scraping from the cervix (pap smear).
- Bimanual palpation of the uterus may be done with two fingers inserted in the vagina while the gynecologist will palpate the uterus from the outside on the lower part of the abdomen.
- A rectovaginal examination may be done where the gynecologist will insert one finger in the vagina and another in the rectum. This procedure is not often conducted unless your gynecologist suspects pathology in this area.
A bimanual palpation of the uterus and rectovaginal examination may not be conducted but this is at your gynecologist’s discretion.
- An ultrasound is usually conducted to identify any cysts in the ovaries, fetus in woman who are pregnanct and other gynecological abnormalities. Some gynecologists may not conduct an ultrasound in women who are not pregnant and do not have any specific primary complaint.
Other Tests & Diagnostic Investigation
- Your pap smear will be sent to the laboratory for analysis of the cells of the cervix.
- Your gynecologist may request a hormone screen (blood test) to identify any high or low hormone levels, particularly in cases of infertility, endometriosis and polycystic ovary syndrome (PCOS). A menopause screen is conducted in older women.
- A quantitative and qualitative beta-HCG blood test may be conducted when pregnancy is suspected and there is no conclusive findings on the ultrasound.
- A glucose tolerance test may be requested in pregnant women with signs of diabetes (gestational diabetes).
- Rarely, an AFP (alpha-fetoprotein) blood test may be conducted if cancer is suspected. This test is not always conclusive.
- A mammogram may need to be conducted in women with a high risk of breast cancer.
- An amniocentesis may be considered in pregnant women older than 35 years (this age may differ in certain countries). A thin needle is inserted into the uterus and amniotic fluid is extracted (fine needle aspiration) and sent for testing to identify certain fetal deformities and genetic disorders like Down’s syndrome.