Carboniferous aquifer complex. Hydrogeology of the Moscow region. Kazan aquifer complex

Research methods in gynecology are divided into:

Special (main):

· Survey, general examination and history taking.

· Examination of the external genitalia.

· Inspection on mirrors.

· Bimanual vaginal examination.

· Combined rectal-vaginal-abdominal wall examination

Additional:

· Bacterioscopy – smear for purity, smear for hormonal saturation, smear for oncocytology.

· Tests functional diagnostics– symptoms of “pupil” and “fern”, measurement basal temperature, radioimmunological method for determining hormones in the blood.

· Probing of the uterine cavity - to determine the position of the uterus, the direction and length of the uterine cavity, the presence of submucosal nodes, polyps and to determine developmental anomalies.

· Biopsy – taking a piece of tissue for morphological examination.

· Bacteriological research– culture of any pathological material from the genital organs for secondary flora ( vaginal discharge, menstrual blood, material from the uterine cavity, puncture contents posterior arch, operational material, i.e. fluid, pus, pieces of tissue).

Endometrial biopsy ( diagnostic curettage) - by vacuum - aspiration or curette. The resulting material is sent for histological examination.

· Puncture abdominal cavity through the posterior vaginal fornix.

· Posterior colpotamia.

Other methods:

· Ultrasound – echography of the pelvic organs.

· Colposcopy is a visual examination using a special optical device (colposcope), giving a magnification of 6-28-40 times.

· Hysteroscopy – visual examination of the inner walls of the uterus (endometrium) using an optical device (hysteroscope).

· Laparoscopy – examination of the abdominal and pelvic organs optical device(laparoscope), which is inserted into the abdominal cavity in an operating room.

· Overview X-ray abdominal cavity and pelvis.

· Hysterosalpingography – radiopaque examination of the uterus (hister) and fallopian tubes (salpinx).

· P – graph of the skull and sella turcica – for diagnosing the pathology of the brain and its process – the pituitary gland.

· CT scan.

· Lymphography, fistulography.

· Breast palpation and mammography.

All examinations of gynecological patients should begin with a survey of patients, which should be conducted tactfully, confidentially, and patiently. The main thing during the examination is to make it clear to the woman that they want to help her.

General inspection: general development, body structure, curvatures pelvic bones traces of operations, etc.

General history: Find out age, profession, living conditions, nutrition, bad habits, past illnesses, husband's health, heredity.

Gynecological history: age of menarche, frequency, intensity of bleeding, number of days, pain during menstruation, date of last menstruation. Beginning of sexual activity, time of first pregnancy. Features of sexual function. Features of the climacteric transition. Duration of menopause. Gynecological diseases, operations on reproductive organs, separated results.

Obstetric history: Number of pregnancies, number of births, miscarriages, abortions, duration of the last pregnancy and its outcome. Use of contraceptives.

Complaints: Pain. Beli. Violation menstrual cycle. Reproductive and sexual dysfunctions. Violations from neighboring and other organs.

Algorithm for examining the external genitalia.

Indications:

· Assessment of physical development.

Equipment:

· Gynecological chair.

· Individual diaper.

· Sterile gloves.

1. Explain to the woman the need for this study.

2. Ask the woman to undress.

3. Clean the gynecological chair with a rag moistened with a 0.5% calcium hypochlorite solution and lay down a clean diaper.

4. Place the woman on the gynecological chair.

5. Perform hand hygiene:

1. Apply 3-5 ml of antiseptic to your hands (70% alcohol or thoroughly wash your hands with soap).

Wash your hands using the following technique:

Vigorous friction of palms – 10 seconds, repeat mechanically 5 times;

The right palm is washed (disinfected) with rubbing movements. back side left hand, then the left palm washes the right palm in the same way, repeat 5 times;

Left palm located on right hand; fingers intertwined, repeat 5 times;

Alternating friction thumbs one hand with the palms of the other (palms clenched), repeat 5 times;

Alternating friction of the palm of one hand with the closed fingers of the other hand, repeat 5 times;

2. Rinse your hands under running water, holding them so that your wrists and hands are below elbow level.

3. Close the tap (using a paper napkin).

4. Dry your hands with a paper towel.

If it is not possible to hygienically wash your hands with water, you can treat them with 3-5 ml of antiseptic (based on 70% alcohol), apply it to your hands and rub until dry (do not wipe your hands). It is important to observe the exposure time - hands must be wet from the antiseptic for at least 15 seconds.

5. Put on clean, sterile gloves:

Remove rings and jewelry;

Wash the hands in the necessary way(regular or hygienic

hand treatment);

Open the top package on disposable gloves and remove with tweezers

gloves in inner packaging;

Use sterile tweezers to unscrew the top edges of the standard packaging,

in it, the gloves lie with the palm surface up, and the edges of the gloves

turned outward in the form of cuffs;

Thumb and index finger right hand take over from within

turn out the edge of the left glove and carefully put it on left hand;

Place the fingers of the left hand (wearing a glove) under the lapel of the back surface of the right glove and put it on the right hand;

Without changing the position of the fingers, unscrew the curved edge of the glove;

Also unscrew the edge of the left glove;

Keep your hands in sterile gloves bent at elbow joints raised forward at a level above the waist;

6. Examine the external genitalia: pubis, growth type hairline whether the labia majora and minora cover the genital fissure.

7. With the first and second fingers of the left hand, spread the labia majora and sequentially inspect: the clitoris, urethra, vestibule of the vagina, ducts of the Bartholinian and paraurethral glands, posterior commissure and perineum.

8. With the first and second fingers of your right hand, in the lower third of the labia majora, first on the right, then on the left, palpate the Bartholin glands.

9. The inspection is completed. Ask the woman to get up and get dressed.

10. Removing gloves:

With the fingers of your gloved left hand, grab the surface of the edge of the right glove and remove it with an energetic movement, turning it inside out;

Place the thumb of the right hand (without a glove) inside the left glove and, grasping inner surface, with an energetic movement, remove the glove from your left hand, turning it inside out;

Place used gloves in a safe disposal box (safe disposal box)

11. Wash your hands with soap and water

13. Record the inspection results in the primary documentation.

2. 1. Algorithm for examining the external genitalia.

Indications:

· Assessment of physical development.

Equipment:

· Gynecological chair.

· Individual diaper.

· Sterile gloves.

1. Explain to the woman the need for this study.

2. Ask the woman to undress.

3. Clean the gynecological chair with a rag moistened with a 0.5% calcium hypochlorite solution and lay down a clean diaper.

4. Place the woman on the gynecological chair.

5. Perform hand hygiene:

6. Apply 3-5 ml of antiseptic to your hands (70% alcohol or thoroughly wash your hands with soap).

Wash your hands using the following technique:

Vigorous friction of palms – 10 seconds, repeat mechanically 5 times;

The right palm washes (disinfects) the back of the left hand with rubbing movements, then the left palm washes the right hand in the same way, repeat 5 times;

The left palm is located on the right hand; fingers intertwined, repeat 5 times;

Alternately rubbing the thumbs of one hand with the palms of the other (palms clenched), repeat 5 times;

Alternating friction of the palm of one hand with the closed fingers of the other hand, repeat 5 times;

7. Rinse your hands under running water, holding them so that your wrists and hands are below elbow level.

8. Close the tap (using a paper napkin).

9. Dry your hands with a paper towel.

10. Put on clean, sterile gloves:

· Remove rings and jewelry;

· Wash your hands in the necessary way (regular or hygienic

hand treatment);

· Open the top package of disposable gloves and remove the gloves in the inner package with tweezers;

· Use sterile tweezers to unscrew the upper edges of the standard package, in it the gloves lie with the palm surface up, and the edges of the gloves are turned outward in the form of cuffs;

· With the thumb and index finger of your right hand, grab the inside edge of the left glove from the inside and carefully put it on your left hand;

· Place the fingers of the left hand (wearing a glove) under the lapel of the back surface of the right glove and put it on the right hand;

· Without changing the position of the fingers, unscrew the curved edge of the glove;

· Also unscrew the edge of the left glove;

· Keep your hands in sterile gloves bent at the elbow joints and raised forward at a level above the waist; Examine the external genitalia: pubis, type of hair growth, whether the labia majora and minora cover the genital opening.

11. With the first and second fingers of the left hand, spread the labia majora and sequentially inspect: the clitoris, urethra, vestibule of the vagina, ducts of the Bartholinian and paraurethral glands, posterior commissure and perineum.

12. With the first and second fingers of your right hand, in the lower third of the labia majora, first on the right, then on the left, palpate the Bartholin’s glands.

13. The inspection is completed. Ask the woman to get up and get dressed.

14. Removing gloves:

With the fingers of your gloved left hand, grab the surface of the edge of the right glove and remove it with an energetic movement, turning it inside out;

Place the thumb of the right hand (without a glove) inside the left glove and, grasping the inner surface, vigorously remove the glove from the left hand, turning it inside out;

Place used gloves in a safe disposal box (safe disposal box)

15. Wash your hands with soap and water

16. Record the inspection results in the primary documentation.

A gynecological examination is carried out using sterile instruments (vaginal speculum, tweezers, smear probes, etc.). The gynecologist performs all manipulations only in sterile rubber gloves.

First, the doctor examines the woman’s external genitalia, pays attention to the inner thighs, the condition of the inguinal veins, the presence of pathological pigmentation in the perineal area and the nature of hair growth. Then with his left hand he spreads the labia majora, finds out the presence of vaginal discharge and its nature, and pays attention to the smell. Next, he examines the external opening of the urethra, the vestibule of the vagina and the condition of the hymen. Normally, the genital fissure is in a closed state; when straining, it can open slightly.

The doctor finds out whether straining is accompanied by painful sensations. In women who have given birth, the genital slit gapes during straining. There may be a cystocele - protrusion of the anterior vaginal wall, rectocele - protrusion back wall vagina. In some cases, during straining, involuntary urination and prolapse of the vagina and uterus occur. Then the gynecologist examines the peri anal area- Availability hemorrhoids, cracks, etc.

The appearance of the external genitalia is of great diagnostic importance. For example, underdevelopment of the labia majora and minora, dry and pale vaginal mucosa are signs of estrogen deficiency. Bright cyanotic coloration of the vulva and vagina and abundant transparent discharge indicate an increase in estrogen levels in the body. During pregnancy, the vulva and vagina have a bluish color, which becomes more and more intense towards the end of pregnancy. Underdeveloped labia minora, a large head of the clitoris, a relatively large distance (more than 2 cm) between the external opening of the urethra and the clitoris are signs of an increase in the level of androgens in a woman’s body, which indicates adrenogenital syndrome. If these same symptoms are combined with increased hair growth, a change in voice that becomes rough, absence of menstruation for 6 months or more, and a decrease in the size of the mammary glands, a tumor of the adrenal glands or ovaries can be suspected.

Androgens are male sex hormones that are produced in small quantities in female body. Their main representative is testosterone.

Inflammatory diseases can lead to hyperemia of the skin and mucous membranes of the genital organs, on which purulent plaques and ulcerative defects. All pathologically changed areas are examined by palpation, determining their mobility, consistency, and soreness.

Then an instrumental gynecological examination of the vagina and cervix is performed. For this purpose, various vaginal speculums are used: folded, cylindrical, spoon-shaped, etc. The doctor selects the size of the speculum according to the size of the vagina. Folding speculums with a lock are easy to use, which not only expand the vagina, but also free up the doctor’s hands for other actions - taking smears.

The gynecologist evaluates the condition of the vaginal walls, cervix and its external os, identifies the presence of erosions, endometriosis, pathological discharge and their character (color, volume, smell). The nature of the secretion is of great diagnostic importance. . So, with candidiasis, a white cheesy coating is visualized on the walls of the vagina. Trichomoniasis is characterized by foamy discharge from the genital tract, while gonorrhea is characterized by purulent discharge.

During a gynecological examination of the vagina, the doctor pays attention to the presence of pathological discharge, blood, tissue condition (signs of inflammation, volumetric formations, traumatic injuries, vascular pathologies, endometriosis).

A gynecological examination of the cervix is carried out taking into account the same parameters. In the middle of the menstrual cycle, a clear secretion from the cervical canal is normally noticeable. You can check the symptom of mucus tension, which indicates ovulation - clear mucus is pulled between the fingers into a 10 cm long string. Excessive mucus from the cervix in other phases of the menstrual cycle can be observed with ovarian dysfunction. In the presence of bloody discharge from the external os of the cervix during the intermenstrual period, it is necessary to conduct an examination to exclude uterine cancer. Endocervicitis is accompanied mucopurulent discharge from the external os of the cervix. Often it is difficult to differentiate between erosion and cervical cancer, so a biopsy is performed - pieces of tissue are taken for examination.

During vaginal examination you can detect cervical polyps that are located on the vaginal part or protrude from cervical canal. Both single and multiple polyps are detected. Pathological formations such as tumors and genital warts, are often localized in the vaginal vaults.

During gynecological examination Using mirrors, the doctor takes material from the vagina to study its microflora and from the cervix to cytological examination. The latter is to identify atypical cells, indicating an oncological process.

Vaginal examination can be performed in two ways: one-handed and two-handed. A one-handed vaginal examination is performed with the doctor’s dominant hand, usually the right. With his left hand, the doctor spreads the labia majora, and the index and middle fingers inserts the right hand into the vagina. When performed carefully, this manipulation does not cause discomfort.

During the examination, the doctor assesses the condition:

pelvic muscles;
Bartholin's glands;
urethra (if inflammation occurs, discharge can be squeezed out of it);
vagina - extensibility and folding of the walls, the presence of tumors (scars, etc.), the condition of the vaults, the presence of soreness;
cervix (shape, size, surface relief, consistency, mobility, pain).

Next, the doctor proceeds to a two-manual examination of the internal genital organs. Using a vaginal examination, you can identify endometriosis, inflammation and tumors of the internal genital organs, ovarian cysts, pregnancy, including ectopic, etc. In this case, the position of the uterus, its size and consistency, the condition of the fallopian tubes and ovaries are determined.

Deviations in the position of the uterus make it possible to suspect the presence of a congenital or acquired pathology. Normally, it is located in the small pelvis in the anteversio-anteflexio position. The body of the uterus is deviated anteriorly from the median axis of the body, and its cervix forms an obtuse anteriorly open angle with the body. When the bladder and/or rectum are full, the position of the uterus changes. Its shift to the side is also observed in the presence of tumors of the appendages. In this case, the displacement occurs in the direction opposite to the tumor. When the appendages become inflamed, the uterus often shifts towards the inflammation.

Uterus length nulliparous women equal to 7-8 cm, for those with a history of childbirth - 8-9.5 cm. The average width of the uterine body is 4-5.5 cm. The length of the cervix is normally 0.3 the length of the uterus. Typically, the uterus is pear-shaped and has a smooth surface, so a spherical shape suggests pregnancy or endometriosis; with tumors, it often takes on an irregular shape. During pregnancy, the uterus becomes softer, however, a change in its consistency may also be associated with a tumor process.

Normally, the uterus has some mobility: it may move upward and to the sides. Limitation of mobility indicates adhesions or absence of the uterus, and excessive mobility indicates its weakness ligamentous apparatus.

Normally, palpation of the uterus is painless, therefore pain during two-hand examination is observed with inflammatory and tumor processes in the pelvic cavity.

Next, the gynecologist examines the uterine appendages. Normally, the fallopian tubes are not palpable, and the ovaries can be palpated only in half of the cases in women of asthenic physique. Vaginal-external palpation of the lateral parts of the lower abdomen allows you to identify tumors and adhesions in the pelvic cavity.

When the fallopian tubes are inflamed, they are palpated in the form of a painful thin cord with a round cross-section or nodular thickenings. The latter are most often located in the area of the uterine horns or the isthmus of the fallopian tube. When fluid accumulates in fallopian tube You can palpate to identify an elongated mobile formation in the area of the funnel of the fallopian tube.

Pyosalpinx (accumulation of pus in the fallopian tube) is often fixed by adhesions and has less mobility. An increase in the size of the ovaries can be detected in the middle of the menstrual cycle due to ovulation or during pregnancy. During menopause and the postmenopausal period, the ovaries atrophy - they decrease in size. With extensive inflammatory processes in the small pelvis it is often impossible to palpate separate body, only a painful conglomerate is determined.

The ligaments of the uterus are usually not detected by palpation, but this is possible during pregnancy or a tumor. In these cases, during vaginal-abdominal examination, a cord located from the edges of the uterus to the internal opening of the inguinal canal is palpated. After parametritis, the uterosacral ligaments can be palpated, which run from the posterior surface of the uterus to the sacrum and are better identified during a rectal-vaginal-abdominal wall examination.

Vaginal-abdominal examination of the genital organs with both hands can reveal flattening and overhanging of the vaginal vaults, which indicates the presence of fluid in the abdominal cavity (blood and inflammatory effusion).

With inflammation of the peritoneum, bimanual examination of the woman’s internal genital organs is difficult, as severe pain and muscle tension in the anterior abdominal wall are noted. In this case, the doctor carefully tries to dislodge the cervix. If this manipulation does not cause pain, then, probably, inflammation of the peritoneum is not associated with pathology of the genital organs.

To determine the connection between a tumor in the abdominal cavity and the genital organs, a bimanual examination is performed using bullet forceps: First, speculums are inserted into the vagina and the cervix is exposed. Then they treat it with an antiseptic ( ethyl alcohol) and bullet forceps are applied to the anterior lip of the pharynx of the cervix. The speculum is then removed from the vagina, and the doctor inserts the index and middle fingers of the dominant hand (or just the index finger) into the vagina or rectum. Using the fingers of his other hand, he tries to move the lower pole of the tumor upward. At this time, the physician's assistant moves the uterus downward, pulling it with bullet forceps. This leads to tension on the tumor stalk and makes it possible to palpate it.

If there is no assistant, you can try to move the tumor up and to the sides. Retraction of the handle of the bullet forceps into the vagina during this manipulation indicates a connection between the tumor and the genital organs. With a tumor of the uterine body, the retraction of the forceps handle is more pronounced than with tumors of the uterine appendages. If the tumor is not associated with the genital organs, then its displacement does not cause a change in the position of the forceps in the vagina.

The founder of scientific and operative gynecology in Russia is the gynecologist, professor at Moscow University, Vladimir Fedorovich Snegirev (1847-1916).

In addition to the vaginal-abdominal wall examination of the internal female genital organs, a rectal-abdominal wall examination can be performed. The second method is indicated for examining women who have not been sexually active, with impaired vaginal patency, cervical and ovarian cancer, to determine the condition of the ligamentous apparatus of the uterus and periuterine tissue.

Before such a study, it is necessary to do a cleansing enema. The doctor inserts a finger of one hand into the patient’s rectum and palpates the internal genital organs through the anterior abdominal wall with the other hand. At the same time, the condition of the rectum is assessed: the presence of narrowings and tumors. After completing the rectal-abdominal examination, the doctor examines his gloves for the presence of pathological discharge from the rectum (pus, blood).

In some cases, a vaginal-rectal examination is performed. It is mandatory for women during the postmenopausal period. Thanks to it, it is possible to identify tumors of the vaginal wall, rectum or rectovaginal septum. The gynecologist inserts the index finger into the vagina and the middle finger into the rectum. The examination is carried out with one hand. The mobility of the vaginal-rectal septum, the presence of adhesions, infiltrates, tumors, etc. are determined.

Gynecological examination of girls is carried out similarly. First, a general gynecological examination is performed, then a gynecological examination of the external genitalia, external urethra and anus. If necessary, perform a rectal-abdominal wall examination. For girls under 6 years of age, rectal examination is performed with the little finger. The position, size of the internal genital organs, and the presence of signs of inflammation are determined. If you suspect neoplasms in the genital organs foreign body vagina, bleeding, malformations of the genital organs, a vaginoscopy is performed - a gynecological examination of the vagina and cervix using an endoscopic device (vaginoscope). The doctor performs the manipulation very carefully, trying not to cause defloration.

Examination of gynecological patients is carried out according to the following scheme:

History taking
Objective examination (Status praesens)

Objective research(Status praesens)

Objective research includes:

Research by systems

respiratory organs,
blood circulation,
digestion,
urinary system, etc.

Inspection

assessment of the patient's position, her general condition, consciousness;
anthropometric studies: assessment of constitution type, measurement of height, weight, pelvic dimensions;
measurement blood pressure, pulse, frequency breathing movements in a minute.

Palpation(abdominal organs, mammary glands).

Percussion(abdomen, lungs)

Auscultation(lungs, intestinal peristalsis).

Gynecological examination (Status genitalis)

Used when examining all patients in mandatory after emptying Bladder and preferably after defecation in the patient’s position on the gynecological chair.
Be sure to use sterile reusable or disposable instruments (mirrors, gloves, oilcloth lining).

examination of the external genitalia;
assessment of the nature and degree of development of sexual characteristics;
inspection using mirrors;
two-manual vaginal examination;
rectovaginal examination;
rectal examination.

Examination of the external genitalia

When examining, pay attention to the severity of hair growth in the pubic area and labia majora, possible pathological changes(swelling, tumors, atrophy, pigmentation, etc.), the height and shape of the perineum (high, low, trough-shaped), its ruptures and their degree, the state of the genital slit (closed or gaping), prolapse of the vaginal walls (independent and with straining).
When spreading the genital fissure, it is necessary to pay attention to the color of the mucous membrane of the vulva, examine the condition of the external opening of the urethra, paraurethral passages, excretory ducts of the large glands of the vestibule of the vagina, and pay attention to the nature of the vaginal discharge.
After examining the external genitalia, you should examine the anal area (the presence of fissures, hemorrhoids, etc.).
The condition of the hymen is determined (its integrity, the shape of the hole).

Algorithm of actions during a gynecological examination

Treat the chair with a disinfectant solution.
Place a disinfected oilcloth on the chair.
Invite the patient to lie down on a chair.
Wear sterile gloves.
Examine the external genitalia visually (pubis, character and degree of hair growth; labia majora - cover the labia minora or not).
Spread your index finger and thumb left hand labia majora.
Inspect visually: clitoris, labia minora, vestibule of the vagina, hymen.

Inspection using mirrors

After examining the external genitalia, they begin research using mirrors, which has a very great importance in gynecology to identify pathological changes in the vagina and cervix.
Examination using vaginal speculum helps to promptly identify precancerous diseases of the cervix and the initial manifestations of cancer, as well as diagnose a number of other forms of pathology. Therefore, the study of women using mirrors is mandatory integral part every gynecological examination.

Algorithm for conducting an inspection using mirrors

Place oilcloth on the chair.
Invite the patient to lie down on the gynecological chair.
Treat your hands in one of the following ways.
Wear sterile gloves.
Take the mirror in your right hand.
Spread the labia majora with your left hand, index finger and thumb.
Insert the speculum into the genital slit to the middle of the vagina straight size.
Convert mirror to cross dimension and advance to the posterior fornix, lightly pressing on the perineum.
Hold the lift in your left hand.
Insert the lift into the vagina along the spoon-shaped speculum to the middle in a straight size, then transfer it to a transverse size.
Advance the lift to the end of the anterior vaginal fornix, pressing lightly on the anterior vaginal wall.
Open up the mirror. Examine the vaginal walls and cervix.
Remove the mirror from reverse order: first the lift, then the spoon mirror.

Vaginal examination

It is performed by inserting the 2nd and 3rd fingers into the vagina. In this case, it is possible to determine the width of the entrance to the vagina, the condition of the perineum, muscles pelvic floor, vaginal length, depth vaginal vaults, length and condition of the vaginal part of the cervix. This study can also provide insight into the condition of the pelvic walls (bone exostoses).

Bimanual examination

It is carried out using two hands. The 2nd and 3rd fingers of the inner hand are inserted into the vagina, outer hand placed on the front abdominal wall above the pubis. Palpation of organs and tissues is carried out using two hands, while the uterus and uterine appendages are examined, their size, shape, consistency, mobility and soreness. Then a study of the periuterine tissue is carried out, which is palpated only if there are infiltrates and exudate in it.

Two-manual vaginal examination

Place an oilcloth on the gynecological chair.
Place the patient on the gynecological chair.
Treat your hands in one of the following ways.
Wear sterile gloves.
Separate the labia majora and labia minora with the index finger and thumb of the left hand.
Bring the fingers of your right hand into the obstetric position: thumb move to the side, press the ring and little fingers to the palm, straighten and close the middle and index fingers.
Insert a medium and index fingers right hand, pressing on the perineum.
Place the fingers of your right hand in the anterior vaginal fornix.
Place your left hand slightly above the pubic joint on the anterior abdominal wall.
Bring the fingers of both hands together and find the uterus by palpation.
Determine the position, size, shape, consistency, mobility and sensitivity of the uterus.
Move the fingers of the outer and inner hands alternately to the lateral vaults of the vagina.
Determine the condition of the appendages.
Remove the fingers of your right hand from the vagina.

Rectal examination

Performed with the 2nd finger of the right hand. It helps to get an idea of the condition of the cervix, paravaginal and pararectal tissue, and to establish changes in the rectum (narrowing, compression by a tumor, infiltration of the walls, etc.).

Rectovaginal examination

This study is used in patients who are not sexually active (with a preserved hymen). It is performed by inserting the 2nd finger into the vagina, and the 3rd finger into the rectum. This combined study is advisable to use if pathological changes in the parametric tissue and rectouterine muscles are suspected. The examination is performed in a gynecological chair.