A complete general gynecologic examination at the Novakovic Polyclinic includes external and internal genitalia, taking a Pap test, examination of vaginal secretions under a microscope, video colposcopy, bimanual and ultrasound examination.
Gynecological examination should be routinely performed once a year, and according to the latest research, every 6 months. If the patient has certain symptoms such as vaginal discharge, irregular bleeding, pain in the small pelvis, it is necessary to do the examination without further delay.
What does a gynecological examination look like?
• External examination consists of vulvar exam and seeking for signs of irritation, redness, swelling or changes in skin and mucous membranes.
• Internal examinations is performed using an instrument called a speculum.
Applying it to some patients can be painful and uncomfortable. Therefore, the gynecologist has to choose an adequate speculum (size and shape) for each patient and to explain that it is necessary to relax as much as possible, so that the examination itself is less uncomfortable, as gynecological examination, as a rule, should not be painful.
After the use of the speculum, swabs are taken from the vagina and cervix, as well as the Pap smear.
Vaginal and cervical swabs are sent for microbiological analysis to re-evaluate the presence of bacterial and/or mycological infection.
The Pap test is performed as part of screening, that is, for early detection of premalignant and malignant changes in the cervix. The findings are classified into 5 groups, where Class 1 and 2 Pap smear represent normal findings, while other results require further monitoring or examination.
During the internal examination, the cervix is examined with the naked eye, and then with a colposcope. We are looking for characteristic pathological changes that tell us whether it is necessary to examine the cervix with a biopsy, how often to repeat the colposcopic examination and do a Pap test. The external genitalia is also examined with a colposcope, which usually reveals changes characteristic of HPV infection.
Bimanual examination: this examination assesses the condition of the uterus, ovaries, parameters, and Douglas space (the space behind the uterus). This examination can be used to palpate enlarged, uneven (usually myomatically altered) uterus, ovarian tumofacts (cysts and various tumors), fixed internal gynecological organs due to infections in the pelvis, advanced malignant tumors of various origins and other pathological conditions. The examination is performed by the doctor’s placing one or two fingers in the vagina and palpating the gynecological organs over the abdomen with the other hand and assessing their condition, size, mobility and painful sensitivity.
Gynecological ultrasound examination is performed with a vaginal probe which enables more precise and better visualization of gynecological organs. This examination assesses the structure, size, vascularization and relationships between the internal gynecological organs.