Gynaecology – screening examination

Gynaecological screening examinations are important for the early detection of potential diseases and their rapid treatment. These routine examinations are generally painless and offer the physician a good opportunity in a confidential conversation to address questions about contraception or family planning. For symptoms such as abdominal pain, cystitis and other complaints, he can provide competent care, security and clarity.

How is a gynaecological examination performed?

A gynaecological examination is done in four steps:

  1. Inspection of the external female organs
  2. Palpation of the pelvic wall, uterus and ovaries
  3. Cervical smear (Pap smear) for cancer
  4. Ultrasound of the abdominal organs

At the start of the examination, the area of the labia is checked for abnormalities for the early detection of abscesses, colour changes (caused e.g. by Lichen sclerosus or Behҫet’s disease), injuries, cysts or tumours.

The smear test was introduced by a Greek doctor called Papanikolaou, hence the abbreviation Pap test. A swab (smear) is taken from the cervix (opening of the womb) for the early detection of uterine cancer. For a suspected inflammation, a sample of vaginal secretion may be taken and examined for pathogens under the microscope. Abnormal smears are either the result of inflammatory processes caused by bacteria, fungi or viruses or the consequence of hormonal imbalance.

What do Pap smears findings indicate?

What do Pap smears findings indicate? Here is a list of possible results:

  • PAP 0
 Not assessable Repeat required
  • PAP 1
 Normal cell presentation Check-up in 1 year
  • PAP 2
 Inflammatory changes Check-up after 6 – 12 months
  • PAP 3
 More pronounced inflammatory and/or degenerative changes Quick follow-up, possibly biopsy
  • PAP 3d
 Slight/moderate cell changes Quick follow-up, possibly biopsy
  • PAP 3g
 Conspicuous gland cells of the cervical canal/ uterine lining Check-up, curettage
  • PAP 4
 Moderate/severe cell changes Conization (cone biopsy), biopsy
  • PAP 5
 Cervical cancer cells Curettage/ colposcopy/ biopsy

Palpating the sexual organs helps with the detection of pressure-sensitive spots that may indicate infections or cysts.

The ultrasound examination (vaginal sonography) is used to describe the structure of the uterus and the ovaries as well as to measure the dimensions of any cysts or myomas. The structure of the uterus and the ovaries, same as that of the breasts, give an indication of hormonal conditions within the body.

Every gynaecological examination includes an inspection, palpation and ultrasound of breasts and armpits. The doctor feels for noticeable hardenings in the breast tissue and any secretion from the nipples taken into account.

The gynaecological examination concludes with a talk about the results and the generation of a treatment plan where necessary.

Gynaecological screenings aside, you should always visit a gynaecologist if you experience any of the following symptoms:

  • Bleeding and/or pain during intercourse
  • Lumps or other abnormalities in the breast
  • Absence of menstrual periods, even just one
  • Abscesses in the genital or anal region
  • Irregular menstrual periods without obvious reason
  • Vaginal itching or burning

  • Severe abdominal cramps during menstruation
  • Severe discharge
  • Inexplicable abdominal pain
  • Falling of the womb
  • Particularly severe menstrual bleeding

Common complaints

Cystitis

Cystitis is an inflammation of the urinary tract and a very common symptom across all age groups, particularly in women. Its course is frequently harmless, but it is highly unpleasant thanks to the painful urge to pass water.

  • Cause: undercooling, mental strain, the Escherichia coli bacterium
  • Diagnosis: urine test
  • Treatment: natural home remedies (Dr Farmini’s Miracle Drink, see Downloads), antibiotics

Itching (pruritus)

Itching is a symptom that can affect women of all ages.

  • Cause: infections (bacteria, fungi), hormone deficiency (estradiol, testosterone), irritation caused by intimate care products.
  • Diagnosis: blood test, saliva test, smear test
  • Treatment: depending on causes

DNA cytometry

DNA cytometry is a method employed in the further clarification of abnormal cancer smears (Pap test categories 3, 3d and 4). To that end, a swab is taken from the cervix. This method is not used in screening.

HPV

The human papillomavirus (HPV) can colonize the skin or mucous membranes. The prevalence rate in women aged 20 to 24 years is 25%.

  • Transmission: This infection is transmissible by sexual contact.
  • Incubation period: 4 weeks to several months
  • Risk factors: multiple sexual partners, drugs, unprotected intercourse without condom, already existing infections (herpes, HIV), immunosuppression (suppression of the body’s own immune system, e.g. through medication)
  • Symptoms: frequently no noticeable symptoms, rarely itching or burning.
  • Consequences:
    • disappears unnoticed
    • results in the development of genital warts (Condylomata acuminata). These are growths predominantly on the external sexual organs, but also on the cervix, inside the vagina and around the anus. Common culprits are HPV serotypes 6 and 11 (more rarely 40, 42, 44, 50, 61).
    • This triggers a pre-stage to cervical cancer (PAP III/IV).
  • Note: An HPV infection does not mean the inevitable development of cancer. Most men and women experience an HPV infection at least once in their lives without even noticing it.