A routine annual checkup for women includes an internal gynecological examination as well as an ultrasound examination of the uterine adnexa. An internal gynecological examination means that the doctor will observe the patient’s vulva for any abnormal swellings. The doctor places a speculum inside the vagina to observe the vaginal wall and observe for any abnormal discharge from the vagina. Immediately afterwards, the doctor will observe the condition of the cervix, whether there are erosion-like changes and whether there are any bulges on the surface of the cervix. The internal gynecological examination allows the doctor to initially palpate the adnexal region of the uterus for tumors. Ultrasound examination of the uterine adnexa is also included. Ultrasound examination of the uterine adnexa is to observe the condition of the uterine adnexa through imaging, whether there are any tumors growing in the uterine adnexa and the condition of the endometrium, etc. Some hospitals also include white belt examination as part of the routine physical examination to see if the patient has vaginitis. Some hospitals now also add tumor marker tests, which are related to gynecology, including tests related to CA125, CA199, AFP and CEA.