Women's health is the health of the nation. Therefore, medical institutions that provide treatment and prevention of gynecological patients have a responsible task - to reduce the number of diseases of the genital area of women and prevent their occurrence.
This task is all the more difficult because, under modern conditions, there are more and more risk factors for women's diseases related to migration, urbanization, changes in sexual behavior of young people: early sexual life, irresponsible attitude of some young women to marriage and marital fidelity. All this threatens the future reproductive function of such women, and therefore affects demographic indicators and is extremely important for the state as a whole.
Tasks of women's consultation:
• providing qualified obstetric and gynecological care to women living in the service area;
• timely detection and registration of pregnant women (up to 12 weeks);
• systematic monitoring of the pregnant woman, if necessary - sending her to the hospital for treatment or outpatient treatment of complications;
• postpartum care;
• regular preventive cancer examinations, active detection of patients with inflammatory processes, precancerous diseases of the female genital organs, benign and malignant tumors;
• taking identified patients for dispensary registration, their systematic observation, examination and treatment.
• providing social and legal assistance to pregnant women;
• conducting sanitary and educational work, ensuring constant contact with the maternity hospital and gynecological hospital.
One of the important sections of the work of a women's clinic doctor is medical examination.
Medical examination is the active detection of patients in the early stages of the disease, dynamic monitoring and comprehensive treatment, measures to improve working and living conditions, prevent disease, restore efficiency.
Onco-professional examinations
Every woman should undergo a preventive cancer examination twice a year, which consists of:
- examination of the mammary glands
- examination of the cervix in mirrors
- taking a smear for oncocytology
- conducting a bimanual examination
The purpose of oncological examinations is early detection of precancerous and malignant diseases.
Early detection of this pathology makes it possible to prevent the development of chronic forms of malignant tumors.
At women's consultations, "Schools of Motherhood" are created, in which physiopsychoprophylactic preparation of a pregnant woman for childbirth is carried out.
A network of specialized consultations "Marriage and Family", family planning centers, where couples consult on infertility, miscarriage, outpatient examination and treatment of men and women.
One of the important sections of women's counseling is the provision of social and legal assistance on the basis of current legislation. This work is performed by legal advisers who are part of the staff of the medical institution.
I. Subjective examination (history taking):
I.1. Passport data.
I.2. Complaints of the patient with their details.
I.3. Survey on other systems.
I.4. History of the disease.
I.5. Life history.
I.6. Gynecological anamnesis:
a). menstrual function;
b). sexual function;
c). generative function;
d). secretory function.
ІІ. Objective examination:
II.1 General objective examination:
II.1.1. Basic methods:
a) general and local survey;
b) palpation;
c) percussion;
d) auscultation.
II.1.2. Additional methods (laboratory, radiological, endoscopic and others).
ІІ.2. Special (gynecological) examination:
II.2.1. Basic methods of gynecological examinations:
a) examination of the external genitalia;
b) inspection in mirrors;
c) bimanual examination (two-handed);
d) vaginal (one-handed).
II.2.2. Additional methods of gynecological examination:
a) smears;
b) methods of functional diagnostics;
c) endoscopic methods;
d) radiological methods;
e) instrumental methods;
f) ultrasound;
g) bacteriological examination;
g) cytogenetic study;
h) determination of hormones in the blood and their metabolites.
Collection of anamnesis.
First of all, find out:
passport data - surname, name, patronymic, as well as date of birth (age of the woman).
This is due to the fact that the same phenomenon at different ages of a woman's life cycle may have different meanings, for example, the absence of menstruation in young women and women in menopause.
History of the disease.
It is necessary to ask the patient about the onset of the disease - acute or gradual, where and for how long she was treated.
Ask about the reasons that, in the opinion of the woman, led to the disease - hypothermia, physical overload, abortion, trauma, etc.
It is necessary to find out what methods were used to diagnose the disease, about the treatment that has been carried out so far and its effectiveness.
If the disease is chronic, you should specify when the last exacerbation was.
Complaints of the patient
Most often, patients complain of pain, abnormal vaginal discharge, bleeding, and dysfunction of neighboring organs.
Then the details of the complaints are detailed:
- In the presence of pain specify its location, irradiation, nature (aching, cutting, prickly, dagger), periodicity (constant, cramping), intensity, which causes pain, or intensifies, which weakens or disappears.
- At complaints on pathological allocations (white) specify their quantity, color, a smell, a consistence.
- In the presence of bleeding, find out its duration, volume, color of blood, the presence of clots and more.
- Also interviewed by other systems: actively find out whether there are complaints of SS, respiratory, musculoskeletal, digestive, urinary, nervous systems.
Regarding the anamnesis vitae, it is necessary to find out:
- in what conditions the woman grew and was formed,
- as well as the conditions in which she currently lives.
- It is important to fully nourish a woman, especially during puberty.
- Also, the profession and working conditions undoubtedly affect a woman's health.
- Transferred diseases. It is especially important to find out what a woman suffered from as a child and during puberty.
- Be sure to ask if the patient has had tuberculosis or sexually transmitted diseases.
- It is important to find out if there has been surgery on the abdominal organs.
- Of particular importance is the clarification of allergy history, in particular regarding the presence of allergic reactions to certain drugs.
- You should ask if a woman has bad habits (smoking, alcoholism, drug addiction).
Gynecological history
1. Menstrual function reflects the state of the reproductive system and the body as a whole. The main data characterizing this function of the female body are:
age of onset of the first menstruation (menarche),
the amount of blood loss during each menstruation,
presence or absence of pain,
duration of menstruation, its regularity.
If the patient is menopausal, it is necessary to clarify at what age she came, how she went through the transition period, whether there is bloody discharge from the vagina (this may indicate endometrial cancer).
2. Sexual, or sexual, function.
When asking a woman about this feature, you should show special tact.
It is important to know whether a woman is married or not,
availability of other sexual partners,
whether there are no signs of the disease with the beginning of sexual life or with a change of partner.
The method of contraception used by a woman is being clarified.
It is necessary to ask about the main components of sexual function - sexual desire, orgasm.
In the case of sexual dysfunction, it is worth asking whether there were any factors that could negatively affect the manifestations of a woman's sexual function (trauma, rape, etc.).
pain that occurs during intercourse may indicate the presence of inflammatory processes in the peritoneum, uterine appendages, peritoneal tissue, as well as vaginismus.
3. Generative (reproductive) function
The birth of a child is the main function of a woman.
This section should clarify:
- after what period of time from the beginning of sexual life without the use of contraception the first pregnancy occurred,
- how many pregnancies there were,
- what was the course of each pregnancy, how they ended (childbirth or abortion), whether there were premature births, stillbirths, whether children died in the early neonatal period,
- whether there were any complications during and after delivery that were performed during delivery.
- In the case of abortions, it should be clarified whether they were artificial (at the woman's request), involuntary or criminal, when the pregnancy was terminated, or whether there were complications during and after the abortion. If abortions were involuntary - have their causes been identified.
4. Secretory function.
Excessive discharge from the genitals is a sign of gynecological diseases. It is necessary to know about the quantity, smell, appearance (consistency), frequency of secretions, because in different gynecological diseases the nature of secretions is different:
- "Yellow foamy with a putrid odor" - with trichomoniasis,
- "White cheesy" - with candidiasis,
- Watery with a fishy smell - with vaginal dysbacteriosis,
- "Meat slops" - in malignant neoplasms).
General objective examination
Objective examination begins with a general examination.
Pay attention to the course or position of the patient, the color of the skin, state of consciousness, facial expression, type of constitution.
Then conduct a local survey, which is carried out from top to bottom:
At local inspection various sites are considered in more detail, trying to reveal possible pathological changes (rashes, swellings, excessive hair growth, etc.)
Examine the sclera of the eyes, tongue, neck, chest, mammary glands (whether they are symmetrical, whether there are indentations, bulges, skin discoloration), abdomen
(you should pay attention to the shape of the abdomen, determine whether the abdomen is involved in the act of breathing), lower extremities (no edema, varicose veins, trophic ulcers, etc.).
Then conduct a local survey, which is carried out from top to bottom:
At local inspection various sites are considered in more detail, trying to reveal possible pathological changes (rashes, swellings, excessive hair growth, etc.)
Examine the sclera of the eyes, tongue, neck, chest, mammary glands (whether they are symmetrical, whether there are indentations, bulges, skin discoloration), abdomen
(you should pay attention to the shape of the abdomen, determine whether the abdomen is involved in the act of breathing), lower extremities (no edema, varicose veins, trophic ulcers, etc.).
General objective examination (continued)
Palpation is performed in parallel with the examination.
Palpate the thyroid gland, lymph nodes, mammary glands, abdomen, limbs.
Palpation makes it possible to detect the presence or absence of muscle tension of the anterior abdominal wall, positive symptoms of peritoneal irritation. Deep palpation of the abdomen can detect tumors or infiltrates.
Palpation of the mammary glands occupies a special place in the examination of gynecological patients. It is important to identify the presence or absence of seals in the mammary glands, the nature of the discharge from the nipples. If there is secretion from the nipples, the patient needs additional examination.
Percussion (tapping) is used to detect fluid, dense formations or gas in the abdomen.
Abdominal auscultation can be used to determine intestinal peristalsis (in pelvioperitonitis - flaccid, in peritonitis - flaccid or absent). Auscultation is also used for the differential diagnosis of pregnancy and tumors.
All methods of gynecological examination are divided into basic, ie those that are mandatory, and additional, which are performed according to certain indications.
The main methods are:
• examination of the external genitalia;
• examination with the help of mirrors;
• two-handed (vaginal-abdominal and rectal-abdominal) study.
• one-handed vaginal examination.
Begin with an examination of the external genitalia.
Pay attention to the type of pubic hair (female, male or mixed type), the presence or absence of hair on the inner thighs. At the same time note whether there is skin irritation of the inner surface of the thighs, which occurs with excessive secretions. Then examine the labia majora and labia minora - their size, pigmentation, the presence or absence of edema, ulcers, warts, varicose veins. Note the degree of closure of the genital slit.
Then spread the labia and inspect their inner surface (pigmentation, color, presence or absence of ulcers). Be sure to assess the condition of the hymen (whole, torn, fresh gaps). When examining the clitoris, pay attention to its size, immediately inspect the outer opening of the urethra - no discharge, polypoid growths, redness in the area of the paraurethral ducts; palpate the Bartholin's gland, assess the condition of the openings of their excretory ducts (the nature of the secretion, redness, swelling around the openings). Assess the condition of the perineum - the presence of old tears, scars, examine the area of the anus - the presence of hemorrhoids, warts, cracks, ulcers, inversion of the mucous membrane.
By asking a woman to strain, you can determine the presence or absence of sagging or falling off the walls of the vagina or uterus.
After the examination of the external genitalia, the examination is performed with the help of mirrors.
For this purpose, use a spoon-shaped Sims mirror with an Otto lift or a double-leaf Cusco mirror. Disposable sash mirrors have been used recently.
With the help of mirrors examine the cervix, its size, shape (cylindrical, conical), the shape of the outer eye of the cervical canal (round in women who have not given birth, slit-like in those who have given birth). Note the nature of the cervical mucosa (cyanosis, hyperemia), the presence of erosions, ruptures, inversions, warts, redness around the outer eye of the cervical canal, the nature of secretions.
After examination of the neck, the mirror is gradually removed, while inspecting the walls of the vagina. Pay attention to the condition of the mucous membrane (hyperemia, edema), the nature of the discharge.
