A gynecological examination is an important step in diagnosing the cause of the condition during an infertility visit. The doctor needs to find clues to the cause of the condition through careful examination. The gynecological examination for infertility is performed by a specialist fertility doctor, who progressively observes and evaluates the patient’s vulva, vagina, cervix, uterus and adnexa for infertility-related signs and describes them in detail, which is important for further diagnosis and the next step in treatment. Let’s talk about gynecological exams today. When you first visit a fertility center, the doctor will give the patient a gynecological examination. Some patients say: I just had a checkup at another hospital, I don’t need another checkup. Some patients say, “I’m here for infertility, my leukorrhea is low and I don’t have inflammation, so I don’t need to be tested. Why must the fertility doctor give you a gynecological examination? How important is the seemingly simple process of a gynecological exam? A gynecological exam is the most basic test that an OB/GYN will perform to assess the condition of the pelvis and to diagnose gynecology-related diseases. From the outside in, the doctor observes the patient’s vulva, vagina and cervix one by one, and then performs what is clinically known as the “double diagnosis” (pictured above). During the examination, the doctor places one hand on the lower abdomen and the index and middle fingers of the other hand on the vaginal fornix, and the two hands work together to very accurately assess the state of the patient’s cervix, uterine corpus, fallopian tubes and ovaries, and pelvic cavity. Sometimes, for the sake of precision, the doctor will also put the middle finger into the anorectum to fully feel the hidden problems at the back of the uterus, which is called “triple diagnosis”. (Picture below) The professional significance of gynecological examination In today’s modern medicine, where diseases are diagnosed by equipment and instruments, doctors often do not touch the patient, and write a bunch of ultrasound checklists, CT scans, and MRI checklists, even if it is a doctor’s visit. When Mr. Qiu Fa Zu, a pioneer surgeon, was alive, he pointed out the disadvantages of this phenomenon. Doctors no longer “Touch” (contact) the patient, the lack of first-hand information on the diagnosis of disease, the lack of medical humane care, but also the lack of dedication to the medical profession. For infertility patients, pelvic and internal genital manipulation examination is more important. Because some infertility-related conditions, such as pelvic endometriosis, adhesions around the uterus, pelvic inflammatory disease sequelae, not to mention the examination of instrumentation is not necessarily found, even some rough routine gynecological examination will not notice. These clues are often important clues in the diagnosis of infertility. What to pay attention to before the gynecological examination? Except in special circumstances, the gynecological examination should be conducted after the menstrual period is clean, because if the menstrual period is not clean, it will increase the chances of infection through the vagina; if you visit the clinic because of “abnormal vaginal bleeding”, then you still need to do gynecological examination to find out the cause of bleeding. The vulva should be sterilized first and sterile instruments and gloves should be used to prevent infection. A urine-filled bladder in front of the uterus will affect the accuracy of the examination and increase the patient’s discomfort. If a urine test is required, a urine sample should be taken and sent to the laboratory before the pelvic examination. Those with a full stool should be examined after a bowel movement or enema. Do not be nervous during the examination; tight abdominal and pelvic floor muscles are also detrimental to the doctor’s examination. The position for the examination is cystotomy, with the patient’s buttocks resting on the edge of the examining table and both hands flat at the side of the body so that the abdominal muscles are relaxed. Try not to wear tight pants and boots to reduce the time and trouble of removing them. During a gynecological examination, the doctor will often check the breasts at the same time to provide more useful diagnostic information and prevent misdiagnosis. Steps and observational indicators of gynecological examination 1. Vulva: Pay attention to the patient’s body shape and fat distribution, the characteristic range of pubic hair distribution, the presence of abdominal surgical scarring, and verify past surgical history. Vulvar examination provides information for the search of infertility etiology. 2.Vagina: Observe the color and elasticity of the vagina under the speculum, the nature of vaginal secretion, and whether there is any vaginal development deformity. When examining the vagina, the vaginal speculum should be rotated to carefully examine the four walls of the vagina and the fornix, so as not to miss the diagnosis due to the covering of the two lobes of the vaginal speculum. If the congenital development is abnormal, it can be found through simple gynecological examination, which is a cause of infertility. 3, cervix: Observe the cervical morphology, color, and surface secretions. At the same time, specimens of cervical cytology can be collected from the junction of columnar epithelium and squamous epithelium at the external mouth of the cervix or cervical secretions. Celiac disease can be diagnosed through gynecological examination. Lesions of the cervix can also cause infertility. 4, the uterus: to understand the position of the uterus, size, texture, mobility, and there is no tenderness, especially the root of the sacral ligament tenderness. Palpation of the posterior wall of the uterus and the rectal recess of the uterus may indicate the presence of inflammatory adhesions in the pelvis. The importance of the uterus as the site of embryo implantation can be imagined, and an experienced reproductive physician can initially determine the condition of the uterus through gynecological examination. 5.Accessories: Whether there is thickening, pressure and pain, masses in the fallopian tube and ovary area, as well as the various characteristics of the masses, help the doctor to determine the condition of the pelvis. Tubal infertility is a very common factor in infertility, and the doctor can initially determine the condition of the fallopian tubes by touching the feel of the adnexal area. Don’t underestimate these tests, ultrasound, CT and MRI often can’t replace, through the gynecological examination found positive signs, may be the “culprit” of infertility. Patients are advised not to refuse the doctor’s recommendation for a gynecological examination, as the doctor has already fully evaluated the patient’s condition and believes that this examination will have a positive impact on the further diagnosis of the cause of the disease and on the next step of the treatment plan.